Use of reboxetine to treat narcolepsy

ABSTRACT

Described herein are methods of treating narcolepsy with cataplexy, comprising administering reboxetine (including esreboxetine) to a human being in need thereof. Reboxetine (including esreboxetine) may also be used in the manufacture of a medicament for the treatment of narcolepsy with cataplexy. Also disclosed herein are kits comprising a pharmaceutical composition comprising reboxetine (including esreboxetine) and instructions to use the pharmaceutical composition to treat narcolepsy with cataplexy in a human being.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.17/177,554, filed Feb. 17, 2021; which is a division of U.S. patentapplication Ser. No. 17/119,792, filed Dec. 11, 2020, now U.S. Pat. No.11,020,402; which is a continuation-in-part of International Pat. App.No. PCT/US2020/062560, filed Nov. 30, 2020; which is acontinuation-in-part of U.S. patent application Ser. No. 16/740,329,filed Jan. 10, 2020; Ser. No. 16/740,409, filed Jan. 11, 2020; Ser. No.16/740,410, filed Jan. 11, 2020; and Ser. No. 16/740,411, filed Jan. 11,2020; International Pat. App. No. PCT/US2020/062560 also claims thebenefit of U.S. Prov. Pat. App. Nos. 62/943,077, filed Dec. 3, 2019; and62/946,295, filed Dec. 10, 2019; U.S. patent application Ser. No.17/119,792 is also a continuation-in-part of U.S. patent applicationSer. No. 16/740,409, filed Jan. 11, 2020; which is acontinuation-in-part of International Pat. App. No. PCT/US2019/056134,filed Oct. 14, 2019; which claims the benefit of U.S. Prov. Pat. App.No. 62/745,956, filed Oct. 15, 2018; U.S. patent application Ser. No.16/740,409 also claims the benefit of U.S. Prov. Pat. App. Nos.62/943,077, filed Dec. 3, 2019; and 62/946,295, filed Dec. 10, 2019; allof the above applications, U.S. patents issued from, or U.S.publications of any of the above applications are incorporated byreference in their entirety.

BACKGROUND

Narcolepsy is a serious and debilitating neurological condition thatcauses dysregulation of the sleep-wake cycle and is characterizedclinically by excessive daytime sleepiness (EDS), cataplexy, hypnagogichallucinations, sleep paralysis, and disrupted nocturnal sleep.Narcolepsy is estimated to afflict an estimated 185,000 individuals inthe U.S. Cataplexy is seen in an estimated 70% of narcolepsy patientsand is a sudden reduction or loss of muscle tone while a patient isawake, typically triggered by strong emotions such as laughter, fear,anger, stress, or excitement. Type 1 narcolepsy includes cataplexy,while Type 2 narcolepsy does not include cataplexy. Narcolepsyinterferes with cognitive, psychological, and social functioning,increases the risk of work- and driving-related accidents, and isassociated with a 1.5 fold higher mortality rate. Depression is reportedin up to 57% of patients. Unfortunately, currently approved treatmentsare few for this under-diagnosed orphan condition and are limited byvariability in efficacy from patient to patient, tolerability issues andthe need for Drug Enforcement Administration (DEA) scheduling.

SUMMARY

Described herein are methods of treating a nervous system disorder,comprising administering an antidepressant, such as a selectivenorepinephrine inhibitor, e.g. atomoxetine, edivoxetine, reboxetine, orS,S-reboxetine to a human being in need thereof.

Described herein are methods of treating narcolepsy with cataplexy,comprising administering an antidepressant, such as a selectivenorepinephrine inhibitor, e.g. atomoxetine, edivoxetine, or reboxetine(including S,S-reboxetine), to a human being in need thereof.

Some embodiments include use of an antidepressant, such as a selectivenorepinephrine inhibitor, e.g. atomoxetine, edivoxetine, or reboxetine(including S,S-reboxetine), in the manufacture of a medicament for thetreatment of narcolepsy with cataplexy.

Some embodiments include a kit comprising a pharmaceutical compositioncomprising an antidepressant, such as a selective norepinephrineinhibitor, e.g. atomoxetine, edivoxetine, or reboxetine (includingS,S-reboxetine), and instructions to use the pharmaceutical compositionto treat narcolepsy with cataplexy in a human being.

In some embodiments, an antidepressant, such as a selectivenorepinephrine inhibitor, e.g. atomoxetine, edivoxetine, or reboxetine(including S,S-reboxetine), is administered at least once daily for morethan two weeks. In some embodiments, the human being experiences areduction in the number of cataplexy attacks in a week, a reduction inthe Epworth Sleepiness Scale (ESS) score, a reduction in the Maintenanceof Wakefulness Test (MWT) score, a reduction in the Narcolepsy SymptomAssessment Score (NSAQ), a reduction in the Patient Global Impression ofSeverity (PGI-S) score, a score below 4 in the Patient Global Impressionof Change (PGI-C), or a reduction in the Hamilton Depression RatingScale (HAM-D), or improvement in the ability to concentrate (e.g. on theNSAQ) as a result of the treatment.

Some embodiments include a method of rapidly reducing the number ofcataplexy attacks in a human being having narcolepsy with cataplexy,comprising administering about 8 mg to about 10 mg of reboxetine dailyfor at least two weeks to a human being in need thereof, wherein oneweek after the start of the treatment, the human being has at least 30%fewer cataplexy attacks as compared to baseline and the reduction in thenumber of cataplexy attacks is statistically significant as compared toadministering a placebo with p<0.01. In some embodiments, the reductionin the number of cataplexy attacks is statistically significant ascompared to administering a placebo with p<0.001.

Some embodiments include a method of improving the ability toconcentrate comprising administering an antidepressant, such as aselective norepinephrine inhibitor, e.g. atomoxetine, edivoxetine, orreboxetine (including S,S-reboxetine), to a mammal or a human being inneed thereof.

Some embodiments include a method of improving the ability toconcentrate in a human being having narcolepsy with cataplexy,comprising administering about 8 mg to about 10 mg of reboxetine dailyfor at least two weeks to a human being in need thereof, wherein, priorto the start of treatment, the human being has an ability to concentratethat is “average,” “poor,” or “very poor,” and two weeks after the startof the treatment, the human being has an ability to concentrate that is“good” or “very good,” as determined by the Ability to Concentrate Itemof the Narcolepsy Symptom Assessment Questionnaire. In some embodiments,the reboxetine is racemic reboxetine. In some embodiments, thereboxetine is esreboxetine.

Some embodiments include a method of reducing the number of inadvertentnaps in a human being having narcolepsy with cataplexy, comprisingadministering about 8 mg to about 10 mg of reboxetine daily for at leasttwo weeks to a human being in need thereof, wherein two weeks after thestart of the treatment, the human being has at least 20% fewerinadvertent naps per week as compared to the week before the patientfirst receives reboxetine. In some embodiments, the reboxetine isracemic reboxetine. In some embodiments, the reboxetine is esreboxetine.

Some embodiments include a method of improving sleep quality in a humanbeing having narcolepsy with cataplexy, comprising administering about 8mg to about 10 mg of reboxetine daily for at least two weeks to a humanbeing in need thereof, wherein two weeks after the start of thetreatment, the human being reports having improved sleep quality ascompared to the week before the patient first receives reboxetine. Insome embodiments, the reboxetine is racemic reboxetine. In someembodiments, the reboxetine is esreboxetine.

Some embodiments include a method of reducing night awakenings in ahuman being having narcolepsy with cataplexy, comprising administeringabout 8 mg to about 10 mg of reboxetine daily for at least two weeks toa human being in need thereof, wherein two weeks after the start of thetreatment, the human being reports having fewer night awakenings ascompared to the week before the patient first receives reboxetine. Insome embodiments, the reboxetine is racemic reboxetine. In someembodiments, the reboxetine is esreboxetine.

Some embodiments include a method of reducing sleep paralysis in a humanbeing having narcolepsy with cataplexy, comprising administering about 8mg to about 10 mg of reboxetine daily for at least two weeks to a humanbeing in need thereof, wherein two weeks after the start of thetreatment, the human being reports having fewer sleep paralysis episodesas compared to the week before the patient first receives reboxetine. Insome embodiments, the reboxetine is racemic reboxetine. In someembodiments, the reboxetine is esreboxetine.

Some embodiments include a method of reducing hypnagogic hallucinationsin a human being having narcolepsy with cataplexy, comprisingadministering about 8 mg to about 10 mg of reboxetine daily for at leasttwo weeks to a human being in need thereof, wherein two weeks after thestart of the treatment, the human being reports having fewer hypnagogichallucinations as compared to the week before the patient first receivesreboxetine. In some embodiments, the reboxetine is racemic reboxetine.In some embodiments, the reboxetine is esreboxetine.

Some embodiments include a method of improving the ability toconcentrate in a human being suffering from narcolepsy, comprisingadministering reboxetine to a human being in need thereof. In someembodiments, the reboxetine is racemic reboxetine. In some embodiments,the reboxetine is esreboxetine.

Some embodiments include a method of treating narcolepsy with cataplexy,comprising administering reboxetine to a human being in need thereof,wherein reboxetine is administered at least once daily for more than twoweeks, wherein, two weeks after the beginning of treatment, the humanbeing experiences a reduction in the number of cataplexy attacks in aweek, a reduction in the Epworth Sleepiness Scale score, a decrease inthe cataplexy subscore on the Ullanlinna Narcolepsy Scale (NUS), or areduction in the Maintenance of Wakefulness Test score as a result ofthe treatment.

Some embodiments include use of reboxetine in the manufacture of amedicament for the treatment of narcolepsy with cataplexy, whereinreboxetine is administered at least once daily for at least three weeks.In some embodiments, the reboxetine is racemic reboxetine. In someembodiments, the reboxetine is esreboxetine.

Some embodiments include a kit comprising a pharmaceutical compositioncomprising reboxetine and instructions to use the pharmaceuticalcomposition to treat narcolepsy with cataplexy in a human being, whereinreboxetine is administered at least once daily for at least three weeks.In some embodiments, the reboxetine is racemic reboxetine. In someembodiments, the reboxetine is esreboxetine.

Some embodiments include a method of treating fibromyalgia, comprisingadministering esreboxetine to a human being in need thereof, wherein adaily dose of about 1 mg to about 2 mg of esreboxetine is administeredfor at least six weeks, wherein the human being experiences a reductionin fibromyalgia pain during the course of the treatment, as measured bya visual analog scale (VAS) score, that is greater than the reduction inpain that the human being would have experienced by administering aplacebo.

Some embodiments include a method of treating fibromyalgia, comprisingadministering esreboxetine to a human being in need thereof, wherein adaily dose of about 2 mg to about 4 mg of esreboxetine is administeredfor at least six weeks, wherein the human being experiences a reductionin pain during the course of the treatment, as measured by a visualanalog scale (VAS) score, that is greater than the reduction in painthat the human being would have experienced by administering a placebo.

Some embodiments include a method of treating fibromyalgia, comprisingadministering esreboxetine to a human being in need thereof, wherein adaily dose of about 0.5 mg to about 1 mg of esreboxetine is administeredfor at least six weeks, wherein the human being experiences a reductionin pain during the course of the treatment, as measured by a visualanalog scale (VAS) score, that is greater than the reduction in painthat the human being would have experienced by administering a placebo.

BRIEF DESCRIPTION OF THE FIGURES

FIG. 1 depicts the change in weekly cataplexy attacks for human patientswho received reboxetine or placebo as described in Example 22.

FIG. 2 depicts the number of human patients with a 50% or greaterreduction in weekly cataplexy attacks, where the human patients receivedreboxetine or placebo as described in Example 22.

FIG. 3 depicts the number of human patients with a 75% or greaterreduction in weekly cataplexy attacks, where the human patients receivedreboxetine or placebo as described in Example 22.

FIG. 4 depicts the change in Epworth Sleepiness Scale Score for humanpatients who received reboxetine or placebo as described in Example 22.

FIG. 5 depicts the reduction in the weekly frequency of inadvertent napsfor human patients who received reboxetine or placebo as described inExample 22.

FIG. 6 depicts the number of human patients with a 50% or greaterreduction in inadvertent naps, where the human patients receivedreboxetine or placebo as described in Example 22.

FIG. 7 depicts the improvement in the ability to concentrate score forhuman patients who received reboxetine or placebo as described inExample 22.

FIG. 8 depicts the number of human patients with a “very good” or “good”ability to concentrate, where the human patients received reboxetine orplacebo as described in Example 22.

FIG. 9 depicts the proportion of human patients demonstratingimprovement in sleep quality, night awakenings, sleep paralysisepisodes, and hypnagogic hallucinations.

DETAILED DESCRIPTION

An antidepressant, such as reboxetine or S,S-reboxetine, may be used totreat a condition such as a nervous system disorder, including anaddictive disorder (including those due to alcohol, nicotine, and otherpsychoactive substances), a withdrawal syndrome, an adjustment disorder(including depressed mood, anxiety, mixed anxiety and depressed mood,disturbance of conduct, and mixed disturbance of conduct and mood),depression (including major depressive disorder, alone or in combinationwith other antidepressants), an age-associated learning or mentaldisorder (including Alzheimer's disease), anorexia nervosa apathy, anattention-deficit (or another cognitive) disorder due to general medicalconditions, attention-deficit hyperactivity disorder (ADHD), bipolardisorder, bulimia nervosa, chronic fatigue syndrome, chronic or acutestress, chronic pain, conduct disorder, cyclothymic disorder, depression(including adolescent depression and minor depression), dysthymicdisorder, fibromyalgia and other somatoform disorders (includingsomatization disorder, conversion disorder, pain disorder,hypochondriaism, body dysmorphic disorder, undifferentiated somatoformdisorder, and somatoform NOS), generalized anxiety disorder (GAD),incontinence (i.e., stress incontinence, genuine stress incontinence,and mixed incontinence), stress urinary incontinence, an inhalationdisorder, an intoxication disorders (alcohol addiction), mania, migraineheadaches, obesity (e.g., reducing the weight of obese or overweightpatients), an obsessive compulsive disorder or a related spectrumdisorder, oppositional defiant disorder, panic disorder, peripheralneuropathy, post-traumatic stress disorder, premenstrual dysphoricdisorder (i.e., premenstrual syndrome and late luteal phase dysphoricdisorder), a psychotic disorder (including schizophrenia, negativesymptoms of schizophrenia, schizoaffective or schizophreniform disorder,either alone or as an adjuvant therapy), seasonal affective disorder, asleep disorder (such as narcolepsy or enuresis), social phobia(including social anxiety disorder), a specific developmental disorder,selective serotonin reuptake inhibition (SSRI) “poop out” syndrome(i.e., wherein a patient who fails to maintain a satisfactory responseto SSRI therapy after an initial period of satisfactory response), TICdisorders (e.g., Tourette's Disease), post-shingles pain, painfuldiabetic peripheral neuropathy, postherpetic neuralgia, syncope, and/orvasovagal syncope, etc. In some embodiments, S,S-reboxetine is used totreat fibromyalgia. In some embodiments, reboxetine is used to treatfibromyalgia.

Treatment with reboxetine (including S,S-reboxetine), may result inimprovement of the symptoms of a disease. For example, for painconditions such as fibromyalgia, the patient may experience a reductionin pain measured on a visual analog scale (VAS), such as 0-100 mm, whichis greater than what would be experienced by administering a placebo. Insome embodiments, the improvement in VAS score be at least about 10%, atleast about 20%, at least about 30%, at least about 40%, at least about50%, at least about 60%, at least about 70%, at least about 80%, atleast about 90%, about 1-5%, about 1-10%, about 10-20%, about 20-30%,about 30-40%, about 40-50%, about 50-60%, about 60-70%, about 70-80%,about 80-90%, about 90-100%, about 1-25%, about 25-50%, about 50-75%, orabout 75-100%, e.g. at least about 50 mm, at least about 40 mm, at leastabout 30 mm, at least about 20 mm, at least about 10 mm, about 0-10 mm,about 10-20 mm, about 20-30 mm, about 30-40 mm, about 40-50 mm, about0-25 mm, or about 25-50 mm more than would be experienced byadministering a placebo. In some embodiments, the improvement in VASscore be at least about 10%, at least about 20%, at least about 30%, atleast about 40%, at least about 50%, at least about 60%, at least about70%, at least about 80%, at least about 90%, about 1-5%, about 1-10%,about 10-20%, about 20-30%, about 30-40%, about 40-50%, about 50-60%,about 60-70%, about 70-80%, about 80-90%, about 90-100%, about 1-25%,about 25-50%, about 50-75%, or about 75-100%, e.g. at least about 50 mm,at least about 40 mm, at least about 30 mm, at least about 20 mm, atleast about 10 mm, about 0-10 mm, about 10-20 mm, about 20-30 mm, about30-40 mm, about 40-50 mm, about 0-25 mm, or about 25-50 mm as comparedto baseline (e.g. right before treatment starts).

An antidepressant, such as bupropion, hydroxybupropion,erythrohydroxybupropion, threohydroxybupropion, clomipramine, doxepin,fluoxetine, mianserin, imipramine, 2-chloroimipramine, amitriptyline,amoxapine, desipramine, protriptyline, trimipramine, nortriptyline,maprotiline, phenelzine, isocarboxazid, tranylcypromine, paroxetine,trazodone, citalopram, sertraline, aryloxy indanamine, benactyzine,escitalopram, fluvoxamine, venlafaxine, desvenlafaxine, duloxetine,mirtazapine, nefazodone, selegiline, sibutramine, milnacipran,tesofensine, brasofensine, moclobemide, rasagiline, nialamide,iproniazid, iproclozide, toloxatone, butriptyline, dosulepin,dibenzepin, iprindole, lofepramine, opipramol, norfluoxetine,dapoxetine, ketamine, etc., including a norepinephrine reuptakeinhibitor such as atomoxetine, edivoxetine, or reboxetine (includingS,S-reboxetine), have the potential to treat the symptoms of narcolepsy.

Many antidepressants, such as norepinephrine reuptake inhibitors, e.g.atomoxetine, edivoxetine, or reboxetine (including S,S-reboxetine), lackof DEA scheduling, which would represent a significant benefit topatients living with this condition.

A person may have Type 1 narcolepsy if Criteria A and B are met:

-   -   A. The patient has daily periods of irrepressible need to sleep        or daytime lapses into sleep occurring for at least 3 months    -   B. The presence of one or both of the following:        -   1. Cataplexy (as defined under Essential Features) and a            mean sleep latency of <8 minutes and Sleep-Onset REM Periods            (SOREMPs) on a Mean Sleep Latency Test (MSLT) performed            according to standard techniques. A SOREMP (within 15            minutes of sleep onset) on the preceding laboratory-based            polysomnography (PSG) may replace one of the SOREMPs on the            MSLT        -   2. CSF hypocretin-1 concentrations measured by            immunoreactivity either <110 pg/mL or <⅓ of mean values            obtained in normal subjects with the same assay

In young children, narcolepsy may sometimes present as excessively longnight sleep or by resumption of previously discontinued daytime napping.If narcolepsy Type 1 is strongly suspected clinically but criteria B2are not met, a possible strategy is to repeat the MSLT

Some patients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) may have, and/ormay be selected for having, daily periods of irrepressible need to sleepor daytime lapses into sleep occurring for at least about 3 months, atleast 4 months, at least about 5 months, at least about 6 months, atleast about 7 months, at least about 8 months, at least about 9 months,at least about 10 months, at least about 11 months, at least about 12months, at least about 13 months, at least about 14 months, at leastabout 15 months, at least about 16 months, at least about 17 months, atleast about 18 months, at least about 2 years, at least about 3 years,at least about 4 years, at least about 5 years, at least about 10 years,at least about 15 years, at least about 20 years, at least about 25years, at least about 30 years, at least about 40 years, at least about50 years, at least about 60 years, about 3-9 months, about 9-18 months,about 18 months to about 2 years, about 2-5 years, about 5-10 years,about 10-15 years, about 15-20 years, about 20-25 years, about 25-30years, about 30-35 years, about 35-40 years, about 40-50 years, about50-60 years, or more.

Some patients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) may have, and/ormay be selected for having, a mean sleep latency of less than about 1minute, less than about 2 minutes, less than about 3 minutes, less thanabout 4 minutes, less than about 5 minutes, less than about 6 minutes,less than about 7 minutes, less than about 8 minutes, about 0.1-1minutes, about 1-2 minutes, about 2-3 minutes, about 3-4 minutes, about4-5 minutes, about 5-6 minutes, about 6-7 minutes, about 7-8 minutes,about 1 minute, about 2 minutes, about 3 minutes, about 4 minutes, about5 minutes, about 6 minutes, about 7 minutes, or about 8 minutes.

Some patients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) may have, and/ormay be selected for having, at least 2, at least 3, or at least 4SOREMPs on an MSLT (Mean Sleep Latency Test) performed according tostandard techniques. A SOREMP within 15 minutes of sleep onset on thepreceding nocturnal PSG may replace one of the SOREMPs on the MSLT

Some patients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) may have, and/ormay be selected for having, CSF hypocretin-1 concentrations measured byimmunoreactivity that are less than about 40 pg/mL, less than about 50pg/mL, less than about 60 pg/mL, less than about 70 pg/mL, less thanabout 80 pg/mL, less than about 90 pg/mL, less than about 100 pg/mL,less than about 110 pg/mL.

Some patients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) may have, and/ormay be selected for having, CSF hypocretin-1 concentrations measured byimmunoreactivity that are less than about 1/10, less than about 1/9,less than about ⅛, less than about 1/7, less than about ⅙, less thanabout ⅕, less than about ¼, or less than about ⅓ of mean values obtainedin normal subjects with the same assay.

Some patients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) may be, and/ormay be selected for being, young children presenting with excessivelylong night sleep.

Some patients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) may be, and/ormay be selected for being, young children presenting with resumption ofpreviously discontinued daytime napping.

Some patients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) may have, and/ormay be selected for having, a diagnosis of narcolepsy with cataplexythat meets the International Classification of Sleep Disorders, ThirdEdition (ICSD-3) criteria.

Some patients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) may have, and/ormay be selected for having, a cataplexy subscore on the UllanlinnaNarcolepsy Score (UNS) that is at least 1, at least about 2, at leastabout 3, at least about 4, at least about 5, at least about 6, at leastabout 7, at least about 8, at least about 9, at least about 10, about11, about 1-2, about 2-3, about 3-4, about 4-5, about 5-6, about 6-7,about 7-8, about 8-9, about 9-10, about 10-11, about 2-4, about 4-6,about 6-8, about 8-10, about 2-6, or about 6-10, or any number between 1and 11.

Some patients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) may have, and/ormay be selected for having, a score on the Epworth Sleepiness Scale(ESS) that is at least about 10, greater than about 10, at least about11, at least about 12, at least about 13, at least about 14, at leastabout 15, at least about 16, at least about 17, at least about 18, atleast about 19, at least about 20, at least about 21, at least about 22,at least about 23, at least about 24, about 10-11, about 11-12, about12-13, about 13-14, about 14-15, about 15-16, about 16-17, about 17-18,about 18-19, about 19-20, about 20-21, about 21-22, about 22-23, about23-24, about 10-13, about 13-16, about 16-19, about 19-22, or about22-24.

Some patients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) may have, and/ormay be selected for having, at least about 7, at least about 8, at leastabout 9, at least about 10, at least about 11, at least about 12, atleast about 13, at least about 14, at least about 15, at least about 16,at least about 17, at least about 18, at least about 19, at least about20, at least about 21, at least about 28, at least about 35, about 7-14,about 14-21, about 21-28, about 28-35, about 35-49, or about 49-70cataplexy attacks per week.

Some patients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) may have, and/ormay be selected for having, a Maintenance of Wakefulness Test (MWT)score that is less than about 1 minutes, less than about 2 minutes, lessthan about 3 minutes, less than about 4 minutes, less than about 5minutes, less than about 6 minutes, less than about 7 minutes, less thanabout 8 minutes, less than about 9 minutes, less than about 10 minutes,less than about 11 minutes, less than about 12 minutes, less than about13 minutes, less than about 14 minutes, less than about 15 minutes, lessthan about 16 minutes, less than about 17 minutes, less than about 18minutes, less than about 19 minutes, less than about 20 minutes, about0-1 minutes, about 1-2 minutes, about 2-3 minutes, about 3-4 minutes,about 4-5 minutes, about 5-6 minutes, about 6-7 minutes, about 7-8minutes, about 8-9 minutes, about 9-10 minutes, about 10-11 minutes,about 11-12 minutes, about 12-13 minutes, about 13-14 minutes, about14-15 minutes, about 15-16 minutes, about 16-17 minutes, about 17-18minutes, about 18-19 minutes, about 19-20 minutes, about 0-4 minutes,about 4-8 minutes, about 8-12 minutes, about 12-16 minutes, about 16-20,or about 0-19 minutes.

In some embodiments, the patient has had, and/or may be selected forhaving had, symptoms of narcolepsy for about 1-5 years, about 5-10years, about 10-15 years, about 15-20 years, about 20-25 years, about25-30 years, about 30-35 years, about 35-40 years, about 40-45 years,about 45-50 years, about 50-55 years, about 55-60 years, about 60-65years, about 65-70 years, about 70-75, or more than 75 years prior toreceiving an antidepressant, including a norepinephrine inhibitor suchas reboxetine (including S,S-reboxetine) for treatment.

In some embodiments, the patient has, and/or may be selected for having,an age of about 0-18 years, about 18-100 years, about 0-5 years, about5-10 years, about 10-15 years, about 15-18 years, about 18-20 years,about 15-20 years, about 18-25 years, about 20-25 years, about 25-30years, about 30-35 years, about 35-40 years, about 40-45 years, about45-50 years, about 50-55 years, about 55-60 years, about 60-65 years,about 65-70 years, about 70-75, or more than 75 years prior to receivingan antidepressant, including a norepinephrine inhibitor such asreboxetine (including S,S-reboxetine) for treatment.

Some patients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may be, and/or may be selected forbeing female. In some embodiments, the patient may be selected for beingfemale, nonlactating and nonpregnant.

Some patients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may be, and/or may be selected forbeing male.

Some patients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may not have, and/or may be selectedfor not having, any concomitant sleep disorder. Some patients treatedwith an antidepressant, including a norepinephrine inhibitor such asreboxetine (including S,S-reboxetine) for narcolepsy (e.g. withcataplexy and/or EDS) may not have, and/or may be selected for nothaving, any concomitant sleep disorder other than mild sleep apnea (<15events per hour) or mild to moderate sleep apnea (<30 events per hour)with stable treatment. Some patients treated with an antidepressant,including a norepinephrine inhibitor such as reboxetine (includingS,S-reboxetine) for narcolepsy (e.g. with cataplexy and/or EDS) may nothave, and/or may be selected for not having, any clinically significantconditions potentially causing EDS. Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not have, and/or may be selected for not having, any clinicallysignificant psychiatric disorders. Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not have, and/or may be selected for not having, any type ofdepression that was not caused by narcolepsy. Some patients treated withan antidepressant, including a norepinephrine inhibitor such asreboxetine (including S,S-reboxetine) for narcolepsy (e.g. withcataplexy and/or EDS) may not have, and/or may be selected for nothaving, any sleepiness caused by depression that was not caused bynarcolepsy. Some patients treated with an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)for narcolepsy (e.g. with cataplexy and/or EDS) may not have, and/or maybe selected for not having, an affective disorder. Some patients treatedwith an antidepressant, including a norepinephrine inhibitor such asreboxetine (including S,S-reboxetine) for narcolepsy (e.g. withcataplexy and/or EDS) may not have, and/or may be selected for nothaving, a psychiatric disorder. Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not have, and/or may be selected for not having, a cerebralfunction disorder. Some patients treated with an antidepressant,including a norepinephrine inhibitor such as reboxetine (includingS,S-reboxetine) for narcolepsy (e.g. with cataplexy and/or EDS) may nothave, and/or may be selected for not having, a movement disorder. Somepatients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may not have, and/or may be selectedfor not having, a dementia. Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not have, and/or may be selected for not having, a motor neurondisease.

Some patients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may not be concurrently taking sodiumoxybate. Some patients treated with an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)for narcolepsy (e.g. with cataplexy and/or EDS) may not be concurrentlytaking a stimulant. Some patients treated with an antidepressant,including a norepinephrine inhibitor such as reboxetine (includingS,S-reboxetine) for narcolepsy (e.g. with cataplexy and/or EDS) may notbe concurrently taking an anticonvulsant. Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not be concurrently taking clonidine. Some patients treatedwith an antidepressant, including a norepinephrine inhibitor such asreboxetine (including S,S-reboxetine) for narcolepsy (e.g. withcataplexy and/or EDS) may not be concurrently taking a selectiveserotonin reuptake inhibitor (SSRI). Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not be concurrently taking a serotonin and norepinephrinere-uptake inhibitor (SNRI). Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not be concurrently taking a monoamine oxidase inhibitor(MAOI). Some patients treated with an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)for narcolepsy (e.g. with cataplexy and/or EDS) may not be concurrentlytaking a tricyclic antidepressant (TCA). Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not be concurrently taking a hypnotic. Some patients treatedwith an antidepressant, including a norepinephrine inhibitor such asreboxetine (including S,S-reboxetine) for narcolepsy (e.g. withcataplexy and/or EDS) may not be concurrently taking an anxiolytic. Somepatients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may not be concurrently taking asedating antihistamine. Some patients treated with an antidepressant,including a norepinephrine inhibitor such as reboxetine (includingS,S-reboxetine) for narcolepsy (e.g. with cataplexy and/or EDS) may notbe concurrently taking an antipsychotic. Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not be concurrently taking any other medication for thetreatment of narcolepsy or cataplexy.

Some patients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may not have, and/or may be selectedfor not having, a neurodegenerative disease. Some patients treated withan antidepressant, including a norepinephrine inhibitor such asreboxetine (including S,S-reboxetine) for narcolepsy (e.g. withcataplexy and/or EDS) may not have, and/or may be selected for nothaving, a seizure disorder. Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not have, and/or may be selected for not having, a convulsivedisorder. Some patients treated with an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)for narcolepsy (e.g. with cataplexy and/or EDS) may not have, and/or maybe selected for not having, a diagnosis of cancer (except possibly basalcell carcinoma) within the last 5 years.

Some patients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may not have, and/or may be selectedfor not having, a bilirubin level more than 2 times the upper limit ofnormal. Some patients treated with an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)for narcolepsy (e.g. with cataplexy and/or EDS) may not have, and/or maybe selected for not having, an alanine aminotransferase level more than2 times the upper limit of normal. Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not have, and/or may be selected for not having, an aspartateaminotransferase level more than 2 times the upper limit of normal. Somepatients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may not have, and/or may be selectedfor not having, an alkaline phosphatase level more than 2 times theupper limit of normal.

Some patients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may not have, and/or may be selectedfor not having clinically significant hypertension. Some patientstreated with an antidepressant, including a norepinephrine inhibitorsuch as reboxetine (including S,S-reboxetine) for narcolepsy (e.g. withcataplexy and/or EDS) may not have, and/or may be selected for nothaving uncontrolled hypertension. Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not have, and/or may be selected for not having a history ofcardiovascular disease. Some patients treated with an antidepressant,including a norepinephrine inhibitor such as reboxetine (includingS,S-reboxetine) for narcolepsy (e.g. with cataplexy and/or EDS) may nothave, and/or may be selected for not having myocardial infarction. Somepatients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may not have, and/or may be selectedfor not having angina. Some patients treated with an antidepressant,including a norepinephrine inhibitor such as reboxetine (includingS,S-reboxetine) for narcolepsy (e.g. with cataplexy and/or EDS) may nothave, and/or may be selected for not having disrhythmias. Some patientstreated with an antidepressant, including a norepinephrine inhibitorsuch as reboxetine (including S,S-reboxetine) for narcolepsy (e.g. withcataplexy and/or EDS) may not have, and/or may be selected for nothaving cardiac failure.

Some patients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may not have, and/or may be selectedfor not having a history of narrow angle glaucoma. Some patients treatedwith an antidepressant, including a norepinephrine inhibitor such asreboxetine (including S,S-reboxetine) for narcolepsy (e.g. withcataplexy and/or EDS) may not have, and/or may be selected for nothaving gastric bypass. Some patients treated with an antidepressant,including a norepinephrine inhibitor such as reboxetine (includingS,S-reboxetine) for narcolepsy (e.g. with cataplexy and/or EDS) may nothave, and/or may be selected for not having any condition that would beexpected to affect drug absorption.

Some patients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may not have, and/or may be selectedfor not having, headaches. Some patients treated with an antidepressant,including a norepinephrine inhibitor such as reboxetine (includingS,S-reboxetine) for narcolepsy (e.g. with cataplexy and/or EDS) may nothave, and/or may be selected for not having, a depression. Some patientstreated with an antidepressant, including a norepinephrine inhibitorsuch as reboxetine (including S,S-reboxetine) for narcolepsy (e.g. withcataplexy and/or EDS) may not have, and/or may be selected for nothaving, major depression. Some patients treated with an antidepressant,including a norepinephrine inhibitor such as reboxetine (includingS,S-reboxetine) for narcolepsy (e.g. with cataplexy and/or EDS) may nothave, and/or may be selected for not having, a treatment resistantdepression.

Some patients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may not have, and/or may be selectedfor not having, treatment resistant bipolar depression. Some patientstreated with an antidepressant, including a norepinephrine inhibitorsuch as reboxetine (including S,S-reboxetine) for narcolepsy (e.g. withcataplexy and/or EDS) may not have, and/or may be selected for nothaving, a bipolar disorder. Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not have, and/or may be selected for not having, cyclothymia.Some patients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may not have, and/or may be selectedfor not having, a seasonal affective disorder. Some patients treatedwith an antidepressant, including a norepinephrine inhibitor such asreboxetine (including S,S-reboxetine) for narcolepsy (e.g. withcataplexy and/or EDS) may not have, and/or may be selected for nothaving, a mood disorder. Some patients treated with an antidepressant,including a norepinephrine inhibitor such as reboxetine (includingS,S-reboxetine) for narcolepsy (e.g. with cataplexy and/or EDS) may nothave, and/or may be selected for not having, chronic depression (e.g.dysthymia). Some patients treated with an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)for narcolepsy (e.g. with cataplexy and/or EDS) may not have, and/or maybe selected for not having, a psychotic depression. Some patientstreated with an antidepressant, including a norepinephrine inhibitorsuch as reboxetine (including S,S-reboxetine) for narcolepsy (e.g. withcataplexy and/or EDS) may not have, and/or may be selected for nothaving a history of psychotic episodes. Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not have, and/or may be selected for not having significantrisk of self-injury, suicide, or aggression towards others.

Some patients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may not have, and/or may be selectedfor not having, a postpartum depression. Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not have, and/or may be selected for not having, a premenstrualdysphoric disorder (PMDD). Some patients treated with an antidepressant,including a norepinephrine inhibitor such as reboxetine (includingS,S-reboxetine) for narcolepsy (e.g. with cataplexy and/or EDS) may nothave, and/or may be selected for not having, a situational depression.Some patients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may not have, and/or may be selectedfor not having, an atypical depression. Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not have, and/or may be selected for not having, a mania. Somepatients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may not have, and/or may be selectedfor not having, an anxiety disorder. Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not have, and/or may be selected for not having, attentiondeficit disorder (ADD).

Some patients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may not have, and/or may be selectedfor not having, attention deficit disorder with hyperactivity (ADDH).Some patients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may not have, and/or may be selectedfor not having, attention deficit/hyperactivity disorder (AD/HD). Somepatients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may not have, and/or may be selectedfor not having, a manic condition. Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not have, and/or may be selected for not having, anobsessive-compulsive disorder. Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not have, and/or may be selected for not having, a bulimia.Some patients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may not have, and/or may be selectedfor not having, obesity or weight-gain. Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not have, and/or may be selected for not having, a chronicfatigue syndrome.

Some patients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may not have, and/or may be selectedfor not having, a premenstrual syndrome. Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not have, and/or may be selected for not having, a substanceaddiction or abuse. Some patients treated with an antidepressant,including a norepinephrine inhibitor such as reboxetine (includingS,S-reboxetine) for narcolepsy (e.g. with cataplexy and/or EDS) may nothave, and/or may be selected for not having, a nicotine addiction. Somepatients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may not have, and/or may be selectedfor not having, a psycho-sexual dysfunction. Some patients treated withan antidepressant, including a norepinephrine inhibitor such asreboxetine (including S,S-reboxetine) for narcolepsy (e.g. withcataplexy and/or EDS) may not have, and/or may be selected for nothaving, a pseudobulbar affect. Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not have, and/or may be selected for not having, emotionallability.

Some patients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may not have, and/or may be selectedfor not having, an anxiety disorder. Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not have, and/or may be selected for not having, a phobia. Somepatients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may not have, and/or may be selectedfor not having, a generalized anxiety disorder. Some patients treatedwith an antidepressant, including a norepinephrine inhibitor such asreboxetine (including S,S-reboxetine) for narcolepsy (e.g. withcataplexy and/or EDS) may not have, and/or may be selected for nothaving, a social anxiety disorder. Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not have, and/or may be selected for not having, a panicdisorder. Some patients treated with an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)for narcolepsy (e.g. with cataplexy and/or EDS) may not have, and/or maybe selected for not having, an agoraphobia. Some patients treated withan antidepressant, including a norepinephrine inhibitor such asreboxetine (including S,S-reboxetine) for narcolepsy (e.g. withcataplexy and/or EDS) may not have, and/or may be selected for nothaving, an obsessive-compulsive disorder. Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not have, and/or may be selected for not having, post-traumaticstress disorder (PTSD). Some patients treated with an antidepressant,including a norepinephrine inhibitor such as reboxetine (includingS,S-reboxetine) for narcolepsy (e.g. with cataplexy and/or EDS) may nothave, and/or may be selected for not having, a mania.

Some patients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may not have, and/or may be selectedfor not having, a manic depressive illness. Some patients treated withan antidepressant, including a norepinephrine inhibitor such asreboxetine (including S,S-reboxetine) for narcolepsy (e.g. withcataplexy and/or EDS) may not have, and/or may be selected for nothaving, a hypomania. Some patients treated with an antidepressant,including a norepinephrine inhibitor such as reboxetine (includingS,S-reboxetine) for narcolepsy (e.g. with cataplexy and/or EDS) may nothave, and/or may be selected for not having, a unipolar depression. Somepatients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may not have, and/or may be selectedfor not having, a stress disorder. Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not have, and/or may be selected for not having, a somatoformdisorder. Some patients treated with an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)for narcolepsy (e.g. with cataplexy and/or EDS) may not have, and/or maybe selected for not having, a personality disorder. Some patientstreated with an antidepressant, including a norepinephrine inhibitorsuch as reboxetine (including S,S-reboxetine) for narcolepsy (e.g. withcataplexy and/or EDS) may not have, and/or may be selected for nothaving, a psychosis.

Some patients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may not have, and/or may be selectedfor not having, schizophrenia. Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not have, and/or may be selected for not having, a delusionaldisorder. Some patients treated with an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)for narcolepsy (e.g. with cataplexy and/or EDS) may not have, and/or maybe selected for not having, a schizoaffective disorder. Some patientstreated with an antidepressant, including a norepinephrine inhibitorsuch as reboxetine (including S,S-reboxetine) for narcolepsy (e.g. withcataplexy and/or EDS) may not have, and/or may be selected for nothaving, a schizotypy. Some patients treated with an antidepressant,including a norepinephrine inhibitor such as reboxetine (includingS,S-reboxetine) for narcolepsy (e.g. with cataplexy and/or EDS) may nothave, and/or may be selected for not having, aggression. Some patientstreated with an antidepressant, including a norepinephrine inhibitorsuch as reboxetine (including S,S-reboxetine) for narcolepsy (e.g. withcataplexy and/or EDS) may not have, and/or may be selected for nothaving, aggression in Alzheimer's disease. Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not have, and/or may be selected for not having, agitation.Some patients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may not have, and/or may be selectedfor not having, agitation in Alzheimer's disease.

Some patients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may not have, and/or may be selectedfor not having, a drug dependence. Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not have, and/or may be selected for not having, addiction tococaine. Some patients treated with an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)for narcolepsy (e.g. with cataplexy and/or EDS) may not have, and/or maybe selected for not having, addiction to or dependence on apsychostimulant. Some patients treated with an antidepressant, includinga norepinephrine inhibitor such as reboxetine (including S,S-reboxetine)for narcolepsy (e.g. with cataplexy and/or EDS) may not have, and/or maybe selected for not having, addiction to or dependence on crack. Somepatients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may not have, and/or may be selectedfor not having, addiction to or dependence on cocaine. Some patientstreated with an antidepressant, including a norepinephrine inhibitorsuch as reboxetine (including S,S-reboxetine) for narcolepsy (e.g. withcataplexy and/or EDS) may not have, and/or may be selected for nothaving, addiction to or dependence on speed. Some patients treated withan antidepressant, including a norepinephrine inhibitor such asreboxetine (including S,S-reboxetine) for narcolepsy (e.g. withcataplexy and/or EDS) may not have, and/or may be selected for nothaving, addiction to or dependence on methamphetamine. Some patientstreated with an antidepressant, including a norepinephrine inhibitorsuch as reboxetine (including S,S-reboxetine) for narcolepsy (e.g. withcataplexy and/or EDS) may not have, and/or may be selected for nothaving, addiction to or dependence on nicotine.

Some patients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may not have, and/or may be selectedfor not having, addiction to or dependence on alcohol. Some patientstreated with an antidepressant, including a norepinephrine inhibitorsuch as reboxetine (including S,S-reboxetine) for narcolepsy (e.g. withcataplexy and/or EDS) may not have, and/or may be selected for nothaving, addiction to or dependence on an opioid. Some patients treatedwith an antidepressant, including a norepinephrine inhibitor such asreboxetine (including S,S-reboxetine) for narcolepsy (e.g. withcataplexy and/or EDS) may not have, and/or may be selected for nothaving, addiction to or dependence on an anxiolytic and/or a hypnoticdrug. Some patients treated with an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)for narcolepsy (e.g. with cataplexy and/or EDS) may not have, and/or maybe selected for not having, addiction to or dependence on a cannabis(marijuana). Some patients treated with an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)for narcolepsy (e.g. with cataplexy and/or EDS) may not have, and/or maybe selected for not having, addiction to or dependence on anamphetamine. Some patients treated with an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)for narcolepsy (e.g. with cataplexy and/or EDS) may not have, and/or maybe selected for not having, addiction to or dependence on ahallucinogen. Some patients treated with an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)for narcolepsy (e.g. with cataplexy and/or EDS) may not have, and/or maybe selected for not having, an addiction to or dependence onphencyclidine.

Some patients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may not have, and/or may be selectedfor not having, addiction to or dependence on a volatile solvent. Somepatients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may not have, and/or may be selectedfor not having, addiction to or dependence on a volatile nitrite. Somepatients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may not have, and/or may be selectedfor not having, senile dementia. Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not have, and/or may be selected for not having, an Alzheimer'stype dementia. Some patients treated with an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)for narcolepsy (e.g. with cataplexy and/or EDS) may not have, and/or maybe selected for not having, memory loss. Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not have, and/or may be selected for not having, anamnesia/amnestic syndrome. Some patients treated with an antidepressant,including a norepinephrine inhibitor such as reboxetine (includingS,S-reboxetine) for narcolepsy (e.g. with cataplexy and/or EDS) may nothave, and/or may be selected for not having, an apilepsy. Some patientstreated with an antidepressant, including a norepinephrine inhibitorsuch as reboxetine (including S,S-reboxetine) for narcolepsy (e.g. withcataplexy and/or EDS) may not have, and/or may be selected for nothaving, disturbances of consciousness.

Some patients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may not have, and/or may be selectedfor not having, a coma. Some patients treated with an antidepressant,including a norepinephrine inhibitor such as reboxetine (includingS,S-reboxetine) for narcolepsy (e.g. with cataplexy and/or EDS) may nothave, and/or may be selected for not having, a lowering of attention.Some patients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may not have, and/or may be selectedfor not having, a speech disorder. Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not have, and/or may be selected for not having, a voice spasm.Some patients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may not have, and/or may be selectedfor not having, Parkinson's disease. Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not have, and/or may be selected for not having, aLennox-Gastaut syndrome.

Some patients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may not have, and/or may be selectedfor not having, autism. Some patients treated with an antidepressant,including a norepinephrine inhibitor such as reboxetine (includingS,S-reboxetine) for narcolepsy (e.g. with cataplexy and/or EDS) may nothave, and/or may be selected for not having, a hyperkinetic syndrome.Some patients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may not have, and/or may be selectedfor not having, schizophrenia. Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not have, and/or may be selected for not having, had a stroke.Some patients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may not have, and/or may be selectedfor not having, a cerebral infarction. Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not have, and/or may be selected for not having, a cerebralbleeding. Some patients treated with an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)for narcolepsy (e.g. with cataplexy and/or EDS) may not have, and/or maybe selected for not having, a cerebral arteriosclerosis. Some patientstreated with an antidepressant, including a norepinephrine inhibitorsuch as reboxetine (including S,S-reboxetine) for narcolepsy (e.g. withcataplexy and/or EDS) may not have, and/or may be selected for nothaving, a cerebral venous thrombosis. Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not have, and/or may be selected for not having, a head injury.

Some patients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may not have, and/or may be selectedfor not having, an akinesia. Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not have, and/or may be selected for not having, an athetosis.Some patients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may not have, and/or may be selectedfor not having, an ataxia. Some patients treated with an antidepressant,including a norepinephrine inhibitor such as reboxetine (includingS,S-reboxetine) for narcolepsy (e.g. with cataplexy and/or EDS) may nothave, and/or may be selected for not having, a ballismus. Some patientstreated with an antidepressant, including a norepinephrine inhibitorsuch as reboxetine (including S,S-reboxetine) for narcolepsy (e.g. withcataplexy and/or EDS) may not have, and/or may be selected for nothaving, a hemiballismus. Some patients treated with an antidepressant,including a norepinephrine inhibitor such as reboxetine (includingS,S-reboxetine) for narcolepsy (e.g. with cataplexy and/or EDS) may nothave, and/or may be selected for not having, a bradykinesia. Somepatients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may not have, and/or may be selectedfor not having, a cerebral palsy.

Some patients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may not have, and/or may be selectedfor not having, a chorea. Some patients treated with an antidepressant,including a norepinephrine inhibitor such as reboxetine (includingS,S-reboxetine) for narcolepsy (e.g. with cataplexy and/or EDS) may nothave, and/or may be selected for not having, Huntington's disease. Somepatients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may not have, and/or may be selectedfor not having, a rheumatic chorea. Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not have, and/or may be selected for not having, a Sydenham'schorea. Some patients treated with an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)for narcolepsy (e.g. with cataplexy and/or EDS) may not have, and/or maybe selected for not having, a dyskinesia. Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not have, and/or may be selected for not having, a tardivedyskinesia. Some patients treated with an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)for narcolepsy (e.g. with cataplexy and/or EDS) may not have, and/or maybe selected for not having, a dystonia. Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not have, and/or may be selected for not having, ablepharospasm.

Some patients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may not have, and/or may be selectedfor not having, a spasmodic torticollis. Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not have, and/or may be selected for not having, adopamine-responsive dystonia. Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not have, and/or may be selected for not having, restless legssyndrome (RLS). Some patients treated with an antidepressant, includinga norepinephrine inhibitor such as reboxetine (including S,S-reboxetine)for narcolepsy (e.g. with cataplexy and/or EDS) may not have, and/or maybe selected for not having, a tremor. Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not have, and/or may be selected for not having, an essentialtremor. Some patients treated with an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)for narcolepsy (e.g. with cataplexy and/or EDS) may not have, and/or maybe selected for not having, Tourette's syndrome. Some patients treatedwith an antidepressant, including a norepinephrine inhibitor such asreboxetine (including S,S-reboxetine) for narcolepsy (e.g. withcataplexy and/or EDS) may not have, and/or may be selected for nothaving, Wilson's disease.

Some patients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may not have, and/or may be selectedfor not having, a vascular dementia. Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not have, and/or may be selected for not having, a dementiawith Lewy bodies. Some patients treated with an antidepressant,including a norepinephrine inhibitor such as reboxetine (includingS,S-reboxetine) for narcolepsy (e.g. with cataplexy and/or EDS) may nothave, and/or may be selected for not having, a mixed dementia. Somepatients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may not have, and/or may be selectedfor not having, a fronto-temporal dementia. Some patients treated withan antidepressant, including a norepinephrine inhibitor such asreboxetine (including S,S-reboxetine) for narcolepsy (e.g. withcataplexy and/or EDS) may not have, and/or may be selected for nothaving, Creutzfeldt-Jakob disease. Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not have, and/or may be selected for not having, a normalpressure hydrocephalus. Some patients treated with an antidepressant,including a norepinephrine inhibitor such as reboxetine (includingS,S-reboxetine) for narcolepsy (e.g. with cataplexy and/or EDS) may nothave, and/or may be selected for not having, Wernicke-KorsakoffSyndrome.

Some patients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may not have, and/or may be selectedfor not having, Pick's disease. Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not have, and/or may be selected for not having, a progressivebulbar palsy. Some patients treated with an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)for narcolepsy (e.g. with cataplexy and/or EDS) may not have, and/or maybe selected for not having, a primary lateral sclerosis (PLS). Somepatients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may not have, and/or may be selectedfor not having, a progressive muscular atrophy. Some patients treatedwith an antidepressant, including a norepinephrine inhibitor such asreboxetine (including S,S-reboxetine) for narcolepsy (e.g. withcataplexy and/or EDS) may not have, and/or may be selected for nothaving, a post-polio syndrome (PPS). Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not have, and/or may be selected for not having, a spinalmuscular atrophy (SMA).

Some patients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may not have, and/or may be selectedfor not having, a spinal motor atrophy. Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not have, and/or may be selected for not having, Tay-Sach'sdisease. Some patients treated with an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)for narcolepsy (e.g. with cataplexy and/or EDS) may not have, and/or maybe selected for not having, a Sandoff disease. Some patients treatedwith an antidepressant, including a norepinephrine inhibitor such asreboxetine (including S,S-reboxetine) for narcolepsy (e.g. withcataplexy and/or EDS) may not have, and/or may be selected for nothaving, a hereditary spastic paraplegia. Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not have, and/or may be selected for not having, Alzheimer'sdisease. Some patients treated with an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)for narcolepsy (e.g. with cataplexy and/or EDS) may not have, and/or maybe selected for not having, a prion-related disease. Some patientstreated with an antidepressant, including a norepinephrine inhibitorsuch as reboxetine (including S,S-reboxetine) for narcolepsy (e.g. withcataplexy and/or EDS) may not have, and/or may be selected for nothaving, a cerebellar ataxia. Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not have, and/or may be selected for not having, aspinocerebellar ataxia (SCA).

Some patients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may not have, and/or may be selectedfor not having, a spinal muscular atrophy (SMA). Some patients treatedwith an antidepressant, including a norepinephrine inhibitor such asreboxetine (including S,S-reboxetine) for narcolepsy (e.g. withcataplexy and/or EDS) may not have, and/or may be selected for nothaving, a bulbar muscular atrophy. Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not have, and/or may be selected for not having, a Friedrich'sataxia. Some patients treated with an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)for narcolepsy (e.g. with cataplexy and/or EDS) may not have, and/or maybe selected for not having, Lewy body disease. Some patients treatedwith an antidepressant, including a norepinephrine inhibitor such asreboxetine (including S,S-reboxetine) for narcolepsy (e.g. withcataplexy and/or EDS) may not have, and/or may be selected for nothaving, amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease).Some patients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may not have, and/or may be selectedfor not having, multiple sclerosis (MS). Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not have, and/or may be selected for not having, a multiplesystem atrophy.

Some patients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may not have, and/or may be selectedfor not having, Shy-Drager syndrome. Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not have, and/or may be selected for not having, a corticobasaldegeneration. Some patients treated with an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)for narcolepsy (e.g. with cataplexy and/or EDS) may not have, and/or maybe selected for not having, a progressive supranuclear palsy.

Some patients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may not have, and/or may be selectedfor not having, Wilson's disease. Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not have, and/or may be selected for not having, Menkesdisease. Some patients treated with an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)for narcolepsy (e.g. with cataplexy and/or EDS) may not have, and/or maybe selected for not having, an adrenoleukodystrophy. Some patientstreated with an antidepressant, including a norepinephrine inhibitorsuch as reboxetine (including S,S-reboxetine) for narcolepsy (e.g. withcataplexy and/or EDS) may not have, and/or may be selected for nothaving, a cerebral autosomal dominant arteriopathy with subcorticalinfarcts and leukoencephalopathy (CADASIL). Some patients treated withan antidepressant, including a norepinephrine inhibitor such asreboxetine (including S,S-reboxetine) for narcolepsy (e.g. withcataplexy and/or EDS) may not have, and/or may be selected for nothaving, a muscular dystrophy.

Some patients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may not have, and/or may be selectedfor not having, a Charcot-Marie-Tooth disease (CMT). Some patientstreated with an antidepressant, including a norepinephrine inhibitorsuch as reboxetine (including S,S-reboxetine) for narcolepsy (e.g. withcataplexy and/or EDS) may not have, and/or may be selected for nothaving, a familial spastic paraparesis. Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not have, and/or may be selected for not having, aneurofibromatosis. Some patients treated with an antidepressant,including a norepinephrine inhibitor such as reboxetine (includingS,S-reboxetine) for narcolepsy (e.g. with cataplexy and/or EDS) may nothave, and/or may be selected for not having, an olivopontine cerebellaratrophy or degeneration. Some patients treated with an antidepressant,including a norepinephrine inhibitor such as reboxetine (includingS,S-reboxetine) for narcolepsy (e.g. with cataplexy and/or EDS) may nothave, and/or may be selected for not having, a striatonigraldegeneration. Some patients treated with an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)for narcolepsy (e.g. with cataplexy and/or EDS) may not have, and/or maybe selected for not having, Guillain-Barr-syndrome. Some patientstreated with an antidepressant, including a norepinephrine inhibitorsuch as reboxetine (including S,S-reboxetine) for narcolepsy (e.g. withcataplexy and/or EDS) may not have, and/or may be selected for nothaving, a spastic paraplesia. Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not have, and/or may be selected for not having, epilepticseizures. Some patients treated with an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)for narcolepsy (e.g. with cataplexy and/or EDS) may not have, and/or maybe selected for not having, nonepileptic seizures. Some patients treatedwith an antidepressant, including a norepinephrine inhibitor such asreboxetine (including S,S-reboxetine) for narcolepsy (e.g. withcataplexy and/or EDS) may not have, and/or may be selected for nothaving, epilepsy. Some patients treated with an antidepressant,including a norepinephrine inhibitor such as reboxetine (includingS,S-reboxetine) for narcolepsy (e.g. with cataplexy and/or EDS) may nothave, and/or may be selected for not having, febrile seizures. Somepatients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may not have, and/or may be selectedfor not having, partial seizures. Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not have, and/or may be selected for not having, simple partialseizures. Some patients treated with an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)for narcolepsy (e.g. with cataplexy and/or EDS) may not have, and/or maybe selected for not having, Jacksonian seizures. Some patients treatedwith an antidepressant, including a norepinephrine inhibitor such asreboxetine (including S,S-reboxetine) for narcolepsy (e.g. withcataplexy and/or EDS) may not have, and/or may be selected for nothaving, complex partial seizures. Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not have, and/or may be selected for not having, an epilepsiapartialis continua. Some patients treated with an antidepressant,including a norepinephrine inhibitor such as reboxetine (includingS,S-reboxetine) for narcolepsy (e.g. with cataplexy and/or EDS) may nothave, and/or may be selected for not having, generalized seizures. Somepatients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may not have, and/or may be selectedfor not having, generalized tonic-clonic seizures. Some patients treatedwith an antidepressant, including a norepinephrine inhibitor such asreboxetine (including S,S-reboxetine) for narcolepsy (e.g. withcataplexy and/or EDS) may not have, and/or may be selected for nothaving, an absence seizure.

Some patients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may not have, and/or may be selectedfor not having, atonic seizures. Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not have, and/or may be selected for not having, myoclonicseizures. Some patients treated with an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)for narcolepsy (e.g. with cataplexy and/or EDS) may not have, and/or maybe selected for not having, juvenile myoclonic seizures. Some patientstreated with an antidepressant, including a norepinephrine inhibitorsuch as reboxetine (including S,S-reboxetine) for narcolepsy (e.g. withcataplexy and/or EDS) may not have, and/or may be selected for nothaving, infantile spasm. Some patients treated with an antidepressant,including a norepinephrine inhibitor such as reboxetine (includingS,S-reboxetine) for narcolepsy (e.g. with cataplexy and/or EDS) may nothave, and/or may be selected for not having, status epilepticus. Somepatients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may not have, and/or may be selectedfor not having, Rett Syndrome. Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not have, and/or may be selected for not having, a tinnitus.Some patients treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsy(e.g. with cataplexy and/or EDS) may not have, and/or may be selectedfor not having, disturbances of consciousness disorders. Some patientstreated with an antidepressant, including a norepinephrine inhibitorsuch as reboxetine (including S,S-reboxetine) for narcolepsy (e.g. withcataplexy and/or EDS) may not have, and/or may be selected for nothaving, a sexual dysfunction. Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not have, and/or may be selected for not having, a voicedisorder due to uncontrolled laryngeal muscle spasms. Some patientstreated with an antidepressant, including a norepinephrine inhibitorsuch as reboxetine (including S,S-reboxetine) for narcolepsy (e.g. withcataplexy and/or EDS) may not have, and/or may be selected for nothaving, an abductor spasmodic dysphonia. Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not have, and/or may be selected for not having, an adductorspasmodic dysphonia. Some patients treated with an antidepressant,including a norepinephrine inhibitor such as reboxetine (includingS,S-reboxetine) for narcolepsy (e.g. with cataplexy and/or EDS) may nothave, and/or may be selected for not having, a muscular tensiondysphonia. Some patients treated with an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)for narcolepsy (e.g. with cataplexy and/or EDS) may not have, and/or maybe selected for not having, a vocal tremor. Some patients treated withan antidepressant, including a norepinephrine inhibitor such asreboxetine (including S,S-reboxetine) for narcolepsy (e.g. withcataplexy and/or EDS) may not have, and/or may be selected for nothaving, a diabetic neuropathy. Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not have, and/or may be selected for not having, achemotherapy-induced neurotoxicity. Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not have, and/or may be selected for not having, methotrexateneurotoxicity. Some patients treated with an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)for narcolepsy (e.g. with cataplexy and/or EDS) may not have, and/or maybe selected for not having, a stress urinary incontinence. Some patientstreated with an antidepressant, including a norepinephrine inhibitorsuch as reboxetine (including S,S-reboxetine) for narcolepsy (e.g. withcataplexy and/or EDS) may not have, and/or may be selected for nothaving, urge urinary incontinence. Some patients treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) for narcolepsy (e.g. with cataplexy and/orEDS) may not have, and/or may be selected for not having, fecalincontinence. Some patients treated with an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)for narcolepsy (e.g. with cataplexy and/or EDS) may not have, and/or maybe selected for not having, erectile dysfunction.

Cataplexy includes a sudden reduction or loss of muscle tone while apatient is awake, which may affect specific parts of the body or theentire body, such as eyelids, head drop, facial sagging and/ortwitching, slurred speech, jaw weakness, weakness in arms, shoulders, orhands, and/or buckling of knees. Cataplexy may be pathognomonic fornarcolepsy. Cataplexy may be triggered by strong emotions, such aslaughter, elation, surprise, or anger. Cataplexy may be partial orlocalized (in about 75% of cases) and is usually of short duration. Thefrequency of cataplexy may vary widely. Narcolepsy with cataplexy may besocially disabling and isolating.

Some patients being treated with an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)may have, and/or may be selected for having, narcolepsy with cataplexy(Type 1) that is an autoimmune disorder resulting in a loss ofhypocretin (orexin)-producing neurons in the CNS. Hypocretins (orexins)are hypothalamic-specific peptides with neuroexcitatory activity. Apatient being treated with an antidepressant, including a norepinephrineinhibitor such as reboxetine (including S,S-reboxetine) for narcolepsywith cataplexy is, and may be selected for being, a predisposedindividual with specific genetic markers including human leukocyteantigen (HLA DQB1/06:02) and/or T-cell receptor alpha variants. Somepatients being treated with an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)may not have, and may be selected for not having, narcolepsy associatedwith loss of hypocretin neurons. Some patients being treated with anantidepressant, including a norepinephrine inhibitor such as reboxetine(including S,S-reboxetine) may have, or may be selected for having,narcolepsy precipitated by seasonal Streptococcus infections, H1N1influenza, and/or H1N1 vaccination in genetically predisposedindividuals.

Existing treatments for narcolepsy only address some of its symptoms,provide variable efficacy, and have significant side effects.Additionally, all existing treatments are controlled substances.

According to the FDA, “there is a continued need for additionaleffective and tolerable treatment options for patients to improve theirdaily functioning.” (The Voice of the Patient, A series of reports fromthe U.S. Food and Drug Administration's (FDA's) Patient-Focused DrugDevelopment Initiative, Narcolepsy, June 2014. p. 25)

In some embodiments, administering an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)may reduce daytime sleepiness by at least about 1%, at least about 5%,at least about 10%, at least about 20%, at least about 30%, at leastabout 40%, at least about 50%, at least about 60%, at least about 70%,at least about 80%, at least about 90%, about 1-5%, about 5-10%, about10-20%, about 20-30%, about 30-40%, about 40-50%, about 50-60%, about60-70%, about 70-80%, about 80-90%, about 90-100%, about 1-25%, about25-50%, about 50-75%, or about 75-100%, e.g. as compared to baseline,placebo, or some other appropriate control (including an active control,such as a stimulant (e.g. methylphenidate, an amphetamine), modafanil,armodafanil, sodium oxybate, a tricyclic antidepressant, a selectiveserotonin reuptake inhibitor (SSRI), or a selective norepinephrinereuptake inhibitor (SNRI)). This improvement may be observed at e.g. 1week, 2 weeks, overall, or at any other relevant time, such as 1 month,6 months, 1 year, 2 years, etc. of the treatment with reboxetine.

In some embodiments, administering an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)may reduce cataplexy by at least about 1%, at least about 5%, at leastabout 10%, at least about 20%, at least about 30%, at least about 40%,at least about 50%, at least about 60%, at least about 70%, at leastabout 80%, at least about 90%, about 1-5%, about 5-10%, about 10-20%,about 20-30%, about 30-40%, about 40-50%, about 50-60%, about 60-70%,about 70-80%, about 80-90%, about 90-100%, about 1-25%, about 25-50%,about 50-75%, or about 75-100%, e.g. as compared to baseline, placebo,or some other appropriate control (including an active control, such asa stimulant (e.g. methylphenidate, an amphetamine), modafanil,armodafanil, sodium oxybate, a tricyclic antidepressant, an SSRI, or anSNRI). This improvement may be observed at e.g. 1 week, 2 weeks,overall, or at any other relevant time, such as 1 month, 6 months, 1year, 2 years, etc. of the treatment with reboxetine.

In some embodiments, administering an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)may reduce the number of partial cataplexy attacks by at least about10%, at least about 20%, at least about 30%, at least about 40%, atleast about 50%, at least about 60%, at least about 70%, at least about80%, at least about 90%, at least about 95%, about 1-10%, about 10-20%,about 20-30%, about 30-40%, about 40-50%, about 40-45%, about 45-50%,about 50-60%, about 60-70%, about 70-80%, about 80-90%, about 90-100%,about 1-25%, about 25-50%, about 50-75%, or about 75-100%, at leastabout 1 per week, at least about 2 per week, at least about 3 per week,at least about 4 per week, at least about 5 per week, at least about 6per week, at least about 7 per week, at least about 8 per week, at leastabout 9 per week, at least about 10 per week, at least about 12 perweek, at least about 13 per week, at least about 14 per week, at leastabout 15 per week, at least about 16 per week, at least about 18 perweek, at least about 20 per week, at least about 22 per week, at leastabout 24 per week, at least about 26 per week, at least about 28 perweek, at least about 30 per week, at least about 40 per week, at leastabout 50 per week, about 1-2 per week, about 2-3 per week, about 3-4 perweek, about 4-5 per week, about 5-6 per week, about 6-7 per week, about7-8 per week, about 8-9 per week, about 9-10 per week, about 10-11 perweek, about 11-12 per week, about 12-13 per week, about 13-14 per week,about 14-15 per week, about 15-16 per week, about 16-17 per week, about17-18 per week, about 18-19 per week, about 19-20 per week, about 1-10per week, about 10-20 per week, about 20-30 per week, about 30-40 perweek, about 40-50 per week, about 50-60 per week, or more, e.g. ascompared to baseline, placebo, or some other appropriate control(including an active control, such as a stimulant (e.g. methylphenidate,an amphetamine), modafanil, armodafanil, sodium oxybate, a tricyclicantidepressant, an SSRI, or an SNRI). This improvement may be observedat e.g. 1 week, 2 weeks, overall, or at any other relevant time, such as1 month, 6 months, 1 year, 2 years, etc. of the treatment withreboxetine. This improvement with the treatment of reboxetine may bestatistically significant (p≤0.05) as compared with administering aplacebo. This improvement may be rapid. For example, at or within oneweek of the treatment with reboxetine in human beings, the averagereduction in cataplexy attacks may be at least about 10%, about 10-20%,about 20-30%, about 30-40%, about 40-50%, about 40-45%, about 45-50%, orabout 50-60%.

In some embodiments, administering an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)may reduce the number of complete cataplexy attacks by at least about10%, at least about 20%, at least about 30%, at least about 40%, atleast about 50%, at least about 60%, at least about 70%, at least about80%, at least about 90%, at least about 95%, about 1-10%, about 10-20%,about 20-30%, about 30-40%, about 40-50%, about 40-45%, about 45-50%,about 50-60%, about 60-70%, about 70-80%, about 80-90%, about 90-100%,about 1-25%, about 25-50%, about 50-75%, or about 75-100%, at leastabout 1 per week, at least about 2 per week, at least about 3 per week,at least about 4 per week, at least about 5 per week, at least about 6per week, at least about 7 per week, at least about 8 per week, at leastabout 9 per week, at least about 10 per week, at least about 12 perweek, at least about 13 per week, at least about 14 per week, at leastabout 15 per week, at least about 16 per week, at least about 18 perweek, at least about 20 per week, at least about 22 per week, at leastabout 24 per week, at least about 26 per week, at least about 28 perweek, at least about 30 per week, at least about 40 per week, at leastabout 50 per week, about 1-2 per week, about 2-3 per week, about 3-4 perweek, about 4-5 per week, about 5-6 per week, about 6-7 per week, about7-8 per week, about 8-9 per week, about 9-10 per week, about 10-11 perweek, about 11-12 per week, about 12-13 per week, about 13-14 per week,about 14-15 per week, about 15-16 per week, about 16-17 per week, about17-18 per week, about 18-19 per week, about 19-20 per week, about 1-10per week, about 10-20 per week, about 20-30 per week, about 30-40 perweek, about 40-50 per week, about 50-60 per week, or more, e.g. ascompared to baseline, placebo, or some other appropriate control(including an active control, such as a stimulant (e.g. methylphenidate,an amphetamine), modafanil, armodafanil, sodium oxybate, a tricyclicantidepressant, an SSRI, or an SNRI). This improvement may be observedat e.g. 1 week, 2 weeks, overall, or at any other relevant time, such as1 month, 6 months, 1 year, 2 years, etc. of the treatment withreboxetine. This improvement with the treatment of reboxetine may bestatistically significant (p≤0.05) as compared with administering aplacebo. This improvement may be rapid. For example, at or within oneweek of the treatment with reboxetine in human beings, the averagereduction in cataplexy attacks may be at least about 10%, about 10-20%,about 20-30%, about 30-40%, about 40-50%, about 40-45%, about 45-50%, orabout 50-60%.

In some embodiments, administering an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)may reduce the total number of cataplexy attacks (partial+complete) byat least about 10%, at least about 20%, at least about 30%, at leastabout 40%, at least about 50%, at least about 60%, at least about 70%,at least about 80%, at least about 90%, at least about 95%, about 1-10%,about 10-20%, about 20-30%, about 30-40%, about 40-50%, about 40-45%,about 45-50%, about 50-60%, about 60-70%, about 70-80%, about 80-90%,about 90-100%, about 1-25%, about 25-50%, about 50-75%, about 75-100%,about 40-60%, at least about 1 per week, at least about 2 per week, atleast about 3 per week, at least about 4 per week, at least about 5 perweek, at least about 6 per week, at least about 7 per week, at leastabout 8 per week, at least about 9 per week, at least about 10 per week,at least about 12 per week, at least about 13 per week, at least about14 per week, at least about 15 per week, at least about 16 per week, atleast about 18 per week, at least about 20 per week, at least about 22per week, at least about 24 per week, at least about 26 per week, atleast about 28 per week, at least about 30 per week, at least about 40per week, at least about 50 per week, at least about 60 per week, atleast about 70 per week, at least about 80 per week, at least about 90per week, at least about 100 per week, at least about 110 per week, atleast about 120 per week, at least about 130 per week, at least about140 per week, about 10-20 per week, about 12-18 per week, about 14-16per week, about 1-2 per week, about 2-3 per week, about 3-4 per week,about 4-5 per week, about 5-6 per week, about 6-7 per week, about 7-8per week, about 8-9 per week, about 9-10 per week, about 10-11 per week,about 11-12 per week, about 12-13 per week, about 13-14 per week, about14-15 per week, about 15-16 per week, about 16-17 per week, about 17-18per week, about 18-19 per week, about 19-20 per week, about 1-10 perweek, about 10-20 per week, about 20-30 per week, about 30-40 per week,about 40-50 per week, about 50-60 per week, about 60-70 per week, about70-80 per week, about 80-90 per week, about 90-100 per week, about100-120 per week, about 120-140 per week, or more, e.g. as compared tobaseline, placebo, or some other appropriate control (including anactive control, such as a stimulant (e.g. methylphenidate, anamphetamine), modafanil, armodafanil, sodium oxybate, a tricyclicantidepressant, an SSRI, or an SNRI). This improvement may be observedat e.g. 1 week, 2 weeks, overall, or at any other relevant time, such as1 month, 6 months, 1 year, 2 years, etc. of the treatment withreboxetine. This improvement with the treatment of reboxetine may bestatistically significant (p≤0.05) as compared with administering aplacebo. This improvement may be rapid. For example, at or within oneweek of the treatment with reboxetine in human beings, the averagereduction in cataplexy attacks may be at least about 10%, about 10-20%,about 20-30%, about 30-40%, about 40-50%, about 40-45%, about 45-50%, orabout 50-60%.

In some embodiments, administering an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)may result in the proportion of patients achieving a 50% or greaterreduction in the weekly number of cataplexy attacks that is about40-50%, about 50-60%, about 50-55%, 55-60%, about 60-70%, about 60-95%,about 70-80%, about 70-75%, about 75-80%, or about 74-78%, e.g. ascompared to baseline, placebo, or some other appropriate control(including an active control, such as a stimulant (e.g. methylphenidate,an amphetamine), modafanil, armodafanil, sodium oxybate, a tricyclicantidepressant, an SSRI, or an SNRI). This improvement may be observedat e.g. 1 week, 2 weeks, overall, or at any other relevant time, such as1 month, 6 months, 1 year, 2 years, etc. of the treatment withreboxetine. This improvement with the treatment of reboxetine may bestatistically significant (p≤0.05) as compared with administering aplacebo.

In some embodiments, administering an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)may result in the proportion of patients achieving a 75% or greaterreduction in the weekly number of cataplexy attacks that is about15-20%, about 20-30%, about 20-25%, about 25-30%, about 30-40%, about40-50%, about 40-45%, about 45-50%, about 50-60%, about 60-70%, about60-95%, or about 70-80%, e.g. as compared to baseline, placebo, or someother appropriate control (including an active control, such as astimulant (e.g. methylphenidate, an amphetamine), modafanil,armodafanil, sodium oxybate, a tricyclic antidepressant, an SSRI, or anSNRI). This improvement may be observed at e.g. 1 week, 2 weeks,overall, or at any other relevant time, such as 1 month, 6 months, 1year, 2 years, etc. of the treatment with reboxetine. This improvementwith the treatment of reboxetine may be statistically significant(p≤0.05) as compared with administering a placebo.

In some embodiments, administering an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)may reduce the Epworth Sleepiness Scale (ESS) score by at least about10%, at least about 20%, at least about 30%, at least about 40%, atleast about 50%, at least about 60%, at least about 70%, at least about80%, at least about 90%, at least about 95%, about 1-10%, about 10-20%,about 20-30%, about 30-40%, about 40-50%, about 50-60%, about 60-70%,about 70-80%, about 80-90%, about 90-100%, about 1-25%, about 25-50%,about 50-75%, or about 75-100%, at least about 1, at least about 2, atleast about 3, at least about 4, at least about 5, at least about 6, atleast about 7, at least about 8, at least about 9, at least about 10, atleast about 11, at least about 12, at least about 13, at least about 14,at least about 15, at least about 16, at least about 17, at least about18, at least about 19, at least about 20, at least about 21, at leastabout 22, at least about 23, about 24, about 1-2, about 2-3, about 3-4,about 4-5, about 5-6, about 6-7, about 7-8, about 8-9, about 9-10, about10-11, about 11-12, about 12-13, about 13-14, about 14-15, about 15-16,about 16-17, about 17-18, about 18-19, about 19-20, about 20-21, about21-22, about 22-23, about 23-24, about 1-4, about 4-8, about 8-12, about12-16, about 16-20, about 20-24, about 1-12, or about 12-24 e.g. ascompared to baseline, placebo, or some other appropriate control(including an active control, such as a stimulant (e.g. methylphenidate,an amphetamine), modafanil, armodafanil, sodium oxybate, a tricyclicantidepressant, an SSRI, or an SNRI). This improvement may be observedat e.g. 1 week, 2 weeks, overall, or at any other relevant time, such as1 month, 6 months, 1 year, 2 years, etc. of the treatment withreboxetine. This improvement with the treatment of reboxetine may bestatistically significant as compared with administering a placebo withp value of ≤0.05, 0.01-0.05, <0.01, 0.005-0.01, 0.001-0.005, or about0.003.

In some embodiments, administering an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)may reduce the weekly number of inadvertent naps by at least about atleast about 10%, at least about 20%, at least about 30%, at least about40%, at least about 50%, at least about 60%, at least about 70%, atleast about 80%, at least about 90%, at least about 95%, about 1-10%,about 10-20%, about 20-30%, about 30-40%, about 40-50%, about 50-60%,about 60-70%, about 70-80%, about 80-90%, about 90-100%, about 1-25%,about 25-50%, about 50-75%, about 75-100%, about 20-40%, about 30-35%,or about 30-33%, at least about 1 nap per week, at least about 2 napsper week, at least about 3 naps per week, at least about 4 naps perweek, at least about 5 naps per week, about 1-3 naps per week, about 2-4naps per week, about 3-4 napes per week, about 3-5 naps per week, about4-6 naps per week, about 5-6 naps per week, e.g. as compared tobaseline, placebo, or some other appropriate control (including anactive control, such as a stimulant (e.g. methylphenidate, anamphetamine), modafanil, armodafanil, sodium oxybate, a tricyclicantidepressant, an SSRI, or an SNRI). This improvement may be observedat e.g. 1 week, 2 weeks, overall, or at any other relevant time, such as1 month, 6 months, 1 year, 2 years, etc. of the treatment withreboxetine. This improvement with the treatment of reboxetine may bestatistically significant as compared with administering a placebo withp value of ≤0.05, 0.03-0.05, 0.01-0.05, <0.01, 0.005-0.01, 0.001-0.005,about 0.003, or <0.001. A patient may be selected for treatment basedupon having a problem with inadvertent naps, such as inadvertent napsassociated with narcolepsy (with or without cataplexy).

In some embodiments, administering an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)may result in the proportion of patients achieving a 50% or greaterreduction in the weekly number of inadvertent naps that is about 15-20%,about 20-30%, about 30-40%, about 30-35%, about 35-40%, about 40-50%,about 50-60%, about 60-70%, or about 70-80%, e.g. as compared tobaseline, placebo, or some other appropriate control (including anactive control, such as a stimulant (e.g. methylphenidate, anamphetamine), modafanil, armodafanil, sodium oxybate, a tricyclicantidepressant, an SSRI, or an SNRI). This improvement may be observedat e.g. 1 week, 2 weeks, overall, or at any other relevant time, such as1 month, 6 months, 1 year, 2 years, etc. of the treatment withreboxetine. This improvement with the treatment of reboxetine may bestatistically significant (p≤0.05) as compared with administering aplacebo.

In some embodiments, administering an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)may reduce the Maintenance of Wakefulness Test (MWT) score by at leastabout 10%, at least about 20%, at least about 30%, at least about 40%,at least about 50%, at least about 60%, at least about 70%, at leastabout 80%, at least about 90%, at least about 95%, about 1-10%, about10-20%, about 20-30%, about 30-40%, about 40-50%, about 50-60%, about60-70%, about 70-80%, about 80-90%, about 90-100%, about 1-25%, about25-50%, about 50-75%, or about 75-100%, at least about 1 minute, atleast about 2 minutes, at least about 3 minutes, at least about 4minutes, at least about 5 minutes, at least about 6 minutes, at leastabout 7 minutes, at least about 8 minutes, at least about 9 minutes, atleast about 10 minutes, at least about 11 minutes, at least about 12minutes, at least about 13 minutes, at least about 14 minutes, at leastabout 15 minutes, at least about 16 minutes, at least about 17 minutes,at least about 18 minutes, at least about 19 minutes, at least about 20minutes, about 1-2 minutes, about 2-3 minutes, about 3-4 minutes, about4-5 minutes, about 5-6 minutes, about 6-7 minutes, about 7-8 minutes,about 8-9 minutes, about 9-10 minutes, about 10-11 minutes, about 11-12minutes, about 12-13 minutes, about 13-14 minutes, about 14-15 minutes,about 15-16 minutes, about 16-17 minutes, about 17-18 minutes, about18-19 minutes, about 19-20 minutes, about 20-21 minutes, about 21-22minutes, about 22-23 minutes, about 23-24 minutes, about 24-26 minutes,about 1-4 minutes, about 4-8 minutes, about 8-12 minutes, about 12-16minutes, about 16-20 minutes, about 1-10 minutes, or about 10-20minutes, e.g. as compared to baseline, placebo, or some otherappropriate control (including an active control, such as a stimulant(e.g. methylphenidate, an amphetamine), modafanil, armodafanil, sodiumoxybate, a tricyclic antidepressant, an SSRI, or an SNRI). Thisimprovement may be observed at e.g. 1 week, 2 weeks, overall, or at anyother relevant time, such as 1 month, 6 months, 1 year, 2 years, etc. ofthe treatment with reboxetine.

In some embodiments, administering an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)may improve cognitive function, e.g. over a 1-week period or a 2-weekperiod, as measured by the Ability to Concentrate item of the NSAQ. Forexample, the improvement in the ability to concentrate score on a5-point scale (1=very good, 2=good, 3=average, 4=poor, and 5=very poor)may be at least about −0.1, at least about −0.2, at least about −0.3,about −0.05 to about −0.5, about −0.05 to about −0.2, about −0.2 toabout −0.3, about 0.3 to about −0.4, about −0.4 to about −0.5, about−0.5 to −0.6, about −0.6 to about −0.7, or about −0.7 to about −0.8,e.g. as compared to baseline, placebo, or some other appropriate control(including an active control, such as a stimulant (e.g. methylphenidate,an amphetamine), modafanil, armodafanil, sodium oxybate, a tricyclicantidepressant, an SSRI, or an SNRI), wherein “−” represents reductionin the ability to concentrate score. In some embodiments, the number ofpatients having an ability to concentrate that is “very good” or “good”may be at least about 20%, at least 25%, at least about 30%, at leastabout 40%, at least about 50%, at least about 60%, at least about 70%,at least about 80%, at least about 90%, at least about 95%, about20-30%, about 30-40%, about 30-35%, about 35-40%, about 40-50%, about40-45%, about 45-50%, about 50-60%, about 60-70%, about 70-80%, about80-90%, about 90-100%, about 1-25%, about 15-25%, about 25-50%, about50-75%, or about 75-100%, about 40-60%, about 35-40%, or about 40-45%,e.g. as compared to baseline, placebo, or some other appropriate control(including an active control, such as a stimulant (e.g. methylphenidate,an amphetamine), modafanil, armodafanil, sodium oxybate, a tricyclicantidepressant, an SSRI, or an SNRI). This improvement may be observedat e.g. 1 week, 2 weeks, overall, or at any other relevant time, such as1 month, 6 months, 1 year, 2 years, etc. of the treatment withreboxetine. This improvement with the treatment of reboxetine may bestatistically significant (p≤0.05) as compared with administering aplacebo, e.g. p=0.01-0.05, <0.01, 0.001-0.01, 0.001-0.005, 0.005-0.01,0.002 or 0.007. A patient may be selected for treatment based uponhaving reduced cognitive function, such as reduced cognitive functionassociated with narcolepsy (with or without cataplexy).

In some embodiments, prior to the start of treatment, the human beinghas an ability to concentrate that is “average,” “poor,” or “very poor,”and one week after the start of the treatment, the human being has anability to concentrate that is “good” or “very good.”

In some embodiments, prior to the start of treatment, the human beinghas an ability to concentrate that is “average,” and one week after thestart of the treatment, the human being has an ability to concentratethat is “good.”

In some embodiments, prior to the start of treatment, the human beinghas an ability to concentrate that is “average,” and one week after thestart of the treatment, the human being has an ability to concentratethat is “very good.”

In some embodiments, prior to the start of treatment, the human beinghas an ability to concentrate that is “poor,” and one week after thestart of the treatment, the human being has an ability to concentratethat is “good.”

In some embodiments, prior to the start of treatment, the human beinghas an ability to concentrate that is “poor,” and one week after thestart of the treatment, the human being has an ability to concentratethat is “very good.”

In some embodiments, prior to the start of treatment, the human beinghas an ability to concentrate that is “very poor,” and one week afterthe start of the treatment, the human being has an ability toconcentrate that is “good.”

In some embodiments, prior to the start of treatment, the human beinghas an ability to concentrate that is “very poor,” and one week afterthe start of the treatment, the human being has an ability toconcentrate that is “very good.”

In some embodiments, prior to the start of treatment, the human beinghas an ability to concentrate that is “average,” “poor,” or “very poor,”and two weeks after the start of the treatment, the human being has anability to concentrate that is “good” or “very good.”

In some embodiments, prior to the start of treatment, the human beinghas an ability to concentrate that is “average,” and two weeks after thestart of the treatment, the human being has an ability to concentratethat is “good.”

In some embodiments, prior to the start of treatment, the human beinghas an ability to concentrate that is “average,” and two weeks after thestart of the treatment, the human being has an ability to concentratethat is “very good.”

In some embodiments, prior to the start of treatment, the human beinghas an ability to concentrate that is “poor,” and two weeks after thestart of the treatment, the human being has an ability to concentratethat is “good.”

In some embodiments, prior to the start of treatment, the human beinghas an ability to concentrate that is “poor,” and two weeks after thestart of the treatment, the human being has an ability to concentratethat is “very good.”

In some embodiments, prior to the start of treatment, the human beinghas an ability to concentrate that is “very poor,” and two weeks afterthe start of the treatment, the human being has an ability toconcentrate that is “good.”

In some embodiments, prior to the start of treatment, the human beinghas an ability to concentrate that is “very poor,” and two weeks afterthe start of the treatment, the human being has an ability toconcentrate that is “very good.”

In some embodiments, administering an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)may improve sleep quality. For example, the patient may report improvedsleep quality. In some embodiments, the number of patients reportingimproved sleep quality may be at least about 20%, at least about 30%, atleast about 40%, at least about 50%, at least about 60%, at least about70%, at least about 80%, at least about 90%, at least about 95%, about20-30%, about 30-40%, about 40-50%, about 50-60%, about 60-70%, about70-80%, about 80-90%, about 90-100%, about 1-25%, about 25-50%, about50-75%, or about 75-100%, about 40-60%, about 42-47%, e.g. as comparedto baseline, placebo, or some other appropriate control (including anactive control, such as a stimulant (e.g. methylphenidate, anamphetamine), modafanil, armodafanil, sodium oxybate, a tricyclicantidepressant, an SSRI, or an SNRI). In some embodiments, a patient mayhave an improvement in sleep quality that is at least about 20%, atleast about 30%, at least about 40%, at least about 50%, at least about60%, at least about 70%, at least about 80%, at least about 90%, atleast about 95%, about 10-20%, about 20-30%, about 30-40%, about 40-50%,about 40-45%, about 45-40%, about 50-60%, about 60-70%, about 70-80%,about 80-90%, about 90-100%, about 1-25%, about 25-50%, about 50-75%, orabout 75-100%, about 40-60%, about 42-47%, or about 45%, e.g. ascompared to baseline, placebo, or some other appropriate control(including an active control, such as a stimulant (e.g. methylphenidate,an amphetamine), modafanil, armodafanil, sodium oxybate, a tricyclicantidepressant, an SSRI, or an SNRI). This improvement may be observedat e.g. 1 week, 2 weeks, overall, or at any other relevant time, such as1 month, 6 months, 1 year, 2 years, etc. of the treatment withreboxetine. This improvement with the treatment of reboxetine may bestatistically significant (p≤0.05) as compared with administering aplacebo, e.g. p=0.01-0.05, <0.01, 0.001-0.01, 0.001-0.005, 0.005-0.01,or 0.007. A patient may be selected for treatment based upon having aproblem with sleep quality, such as a problem with sleep qualityassociated with narcolepsy (with or without cataplexy).

In some embodiments, administering an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)may reduce the number of awakenings at night, e.g. as reported by thepatient. For example, the number of patients reporting a reduction inthe number of awakenings at night may be at least about 20%, at leastabout 30%, at least about 40%, at least about 50%, at least about 60%,at least about 70%, at least about 80%, at least about 90%, at leastabout 95%, about 20-30%, about 30-40%, about 40-50%, about 50-60%, about60-70%, about 70-80%, about 80-90%, about 90-100%, about 1-25%, about25-50%, about 50-75%, or about 75-100%, about 40-60%, about 42-47%, e.g.as compared to baseline, placebo, or some other appropriate control(including an active control, such as a stimulant (e.g. methylphenidate,an amphetamine), modafanil, armodafanil, sodium oxybate, a tricyclicantidepressant, an SSRI, or an SNRI). In some embodiments, a patient mayhave a reduction in the number of awakenings at night that is at leastabout 20%, at least about 30%, at least about 40%, at least about 50%,at least about 60%, at least about 70%, at least about 80%, at leastabout 90%, at least about 95%, about 10-20%, about 20-30%, about 30-40%,about 40-50%, about 50-60%, about 60-70%, about 70-80%, about 80-90%,about 90-100%, about 1-25%, about 25-50%, about 50-75%, or about75-100%, about 40-60%, about 42-47%, or about 30%, e.g. as compared tobaseline, placebo, or some other appropriate control (including anactive control, such as a stimulant (e.g. methylphenidate, anamphetamine), modafanil, armodafanil, sodium oxybate, a tricyclicantidepressant, an SSRI, or an SNRI). This improvement may be observedat e.g. 1 week, 2 weeks, overall, or at any other relevant time, such as1 month, 6 months, 1 year, 2 years, etc. of the treatment withreboxetine. This improvement with the treatment of reboxetine may bestatistically significant (p≤0.05) as compared with administering aplacebo, e.g. p=0.01-0.05, 0.04-0.05, or 0.044. A patient may beselected for treatment based upon having a problem with awakenings atnight, such as a problem with awakenings at night associated withnarcolepsy (with or without cataplexy).

In some embodiments, administering an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)may reduce the number of sleep paralysis episodes, e.g. as reported bythe patient. For example, the number of patients having a reduction inthe number of sleep paralysis episodes may be at least about 20%, atleast about 30%, at least about 40%, at least about 50%, at least about60%, at least about 70%, at least about 80%, at least about 90%, atleast about 95%, about 20-30%, about 30-40%, about 40-50%, about 50-60%,about 60-70%, about 70-80%, about 80-90%, about 90-100%, about 1-25%,about 25-50%, about 50-75%, or about 75-100%, about 50-70%, about52-57%, e.g. as compared to baseline, placebo, or some other appropriatecontrol (including an active control, such as a stimulant (e.g.methylphenidate, an amphetamine), modafanil, armodafanil, sodiumoxybate, a tricyclic antidepressant, an SSRI, or an SNRI). In someembodiments, a patient may have a reduction in the number of sleepparalysis episodes that is at least about 20%, at least about 30%, atleast about 40%, at least about 50%, at least about 60%, at least about70%, at least about 80%, at least about 90%, at least about 95%, about10-20%, about 20-30%, about 30-40%, about 40-50%, about 50-60%, about60-70%, about 70-80%, about 80-90%, about 90-100%, about 1-25%, about25-50%, about 50-75%, or about 75-100%, about 50-70%, about 52-57%, orabout 55%, e.g. as compared to baseline, placebo, or some otherappropriate control (including an active control, such as a stimulant(e.g. methylphenidate, an amphetamine), modafanil, armodafanil, sodiumoxybate, a tricyclic antidepressant, an SSRI, or an SNRI). Thisimprovement may be observed at e.g. 1 week, 2 weeks, overall, or at anyother relevant time, such as 1 month, 6 months, 1 year, 2 years, etc. ofthe treatment with reboxetine. A patient may be selected for treatmentbased upon having a problem with sleep paralysis, such as a problem withsleep paralysis associated with narcolepsy (with or without cataplexy).

In some embodiments, administering an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)may reduce the number of hypnagogic hallucinations, e.g. as reported bythe patient. For example, the number of patients having a reduction inthe number of hypnagogic hallucinations may be at least about 10%, atleast about 20%, at least about 30%, at least about 40%, about 20-30%,about 30-40%, about 40-50%, about 50-60%, about 60-70%, about 70-80%,about 80-90%, about 90-100%, about 1-25%, about 25-50%, about 50-75%, orabout 75-100%, about 30-50%, about 35-45%, e.g. as compared to baseline,placebo, or some other appropriate control (including an active control,such as a stimulant (e.g. methylphenidate, an amphetamine), modafanil,armodafanil, sodium oxybate, a tricyclic antidepressant, an SSRI, or anSNRI). In some embodiments, a patient may have a reduction in the numberof hypnagogic hallucinations that is at least about 10%, at least about20%, at least about 30%, at least about 40%, about 10-20%, about 20-30%,about 30-40%, about 40-50%, about 50-60%, about 60-70%, about 70-80%,about 80-90%, about 90-100%, about 1-25%, about 25-50%, about 50-75%, orabout 75-100%, about 30-50%, about 35-45%, or about 40%, e.g. ascompared to baseline, placebo, or some other appropriate control(including an active control, such as a stimulant (e.g. methylphenidate,an amphetamine), modafanil, armodafanil, sodium oxybate, a tricyclicantidepressant, an SSRI, or an SNRI). This improvement may be observedat e.g. 1 week, 2 weeks, overall, or at any other relevant time, such as1 month, 6 months, 1 year, 2 years, etc. of the treatment withreboxetine. A patient may be selected for treatment based upon problemswith hypnagogic hallucinations, such as hypnagogic hallucinationsassociated with narcolepsy (with or without cataplexy).

In some embodiments, administering an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)may reduce the cataplexy score on the UNS by at least about 10%, atleast about 20%, at least about 30%, at least about 40%, at least about45%, at least about 50%, at least about 60%, at least about 70%, atleast about 80%, at least about 90%, at least about 95%, about 1-10%,about 10-20%, about 20-30%, about 30-40%, about 40-50%, about 45-50%,about 50-60%, about 60-70%, about 70-80%, about 80-90%, about 90-100%,about 1-25%, about 25-50%, about 50-75%, or about 75-100%, at leastabout 1, at least about 2, at least about 3, at least about 4, at leastabout 5, at least about 6, at least about 7, at least about 8, at leastabout 9, at least about 10, about 11, about 2-3, about 3-4, about 4-5,about 5-6, about 6-7, about 7-8, about 8-9, about 9-10, about 2-4, about4-6, about 6-8, about 8-10, about 10-11, about 2-6, or about 6-10, about5-11, e.g. as compared to baseline, placebo, or some other appropriatecontrol (including an active control, such as a stimulant (e.g.methylphenidate, an amphetamine), modafanil, armodafanil, sodiumoxybate, a tricyclic antidepressant, an SSRI, or an SNRI). Thisimprovement may be observed at e.g. 1 week, 2 weeks, overall, or at anyother relevant time, such as 1 month, 6 months, 1 year, 2 years, etc. ofthe treatment with reboxetine.

In some embodiments, administering an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)may increase sleep latency on the MSLT by at least about 30%, at leastabout 50%, at least about 60%, at least about 70%, at least about 80%,at least about 90%, at least about 95%, about 50-60%, more than 55%,about 60-70%, about 70-80%, about 80-90%, about 90-100%, about 50-75%,or about 75-100%, at least about 1 minute, at least about 2 minutes, atleast about 3 minutes, more than 3 minutes, at least about 4 minutes, atleast about 5 minutes, at least about 6 minutes, at least about 7minutes, at least about 8 minutes, at least about 9 minutes, at leastabout 10 minutes, at least about 11 minutes, at least about 12 minutes,at least about 13 minutes, at least about 14 minutes, at least about 15minutes, at least about 16 minutes, at least about 17 minutes, at leastabout 18 minutes, at least about 19 minutes, at least about 20 minutes,about 1-2 minutes, about 2-3 minutes, about 3-4 minutes, about 4-5minutes, about 5-6 minutes, about 6-7 minutes, about 7-8 minutes, about8-9 minutes, about 9-10 minutes, about 10-11 minutes, about 11-12minutes, about 12-13 minutes, about 13-14 minutes, about 14-15 minutes,about 15-16 minutes, about 16-17 minutes, about 17-18 minutes, about18-19 minutes, about 19-20 minutes, about 1-4 minutes, about 4-8minutes, about 8-12 minutes, about 12-16 minutes, about 16-20 minutes,about 1-10 minutes, or about 10-20 minutes, e.g. as compared tobaseline, placebo, or some other appropriate control (including anactive control, such as a stimulant (e.g. methylphenidate, anamphetamine), modafanil, armodafanil, sodium oxybate, a tricyclicantidepressant, an SSRI, or an SNRI). This improvement may be observedat e.g. 1 week, 2 weeks, overall, or at any other relevant time, such as1 month, 6 months, 1 year, 2 years, etc. of the treatment withreboxetine.

In some embodiments, administering an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)may reduce the Patient Global Impression of Severity (PGI-S) score by atleast about 10%, at least about 20%, at least about 30%, at least about40%, at least about 50%, at least about 60%, at least about 70%, atleast about 80%, at least about 90%, at least about 95%, about 1-10%,about 10-20%, about 20-30%, about 30-40%, about 40-50%, about 50-60%,about 60-70%, about 70-80%, about 80-90%, about 90-100%, about 1-25%,about 25-50%, about 50-75%, about 75-100%, at least about 0.1, at leastabout 0.5, at least about 1, at least about 1.5, at least about 2, atleast about 2.5, at least about 3, at least about 3.5, about 0.1-0.5,about 0.5-1, about 1-1.5, about 1.5-2, about 2-2.5, about 2.5-3, about3-3.5, or about 3.5-4, e.g. as compared to baseline, placebo, or someother appropriate control (including an active control, such as astimulant (e.g. methylphenidate, an amphetamine), modafanil,armodafanil, sodium oxybate, a tricyclic antidepressant, an SSRI, or anSNRI). This improvement may be observed at e.g. 1 week, 2 weeks,overall, or at any other relevant time, such as 1 month, 6 months, 1year, 2 years, etc. of the treatment with reboxetine.

In some embodiments, administering an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)may result in a Patient Global Impression of Change (PGI-C) score thatis about 1-2, about 2-3, or about 3-4, or is reduced by at least about10%, at least about 20%, at least about 30%, at least about 40%, atleast about 50%, at least about 60%, at least about 70%, at least about80%, at least about 90%, at least about 95%, about 1-10%, about 10-20%,about 20-30%, about 30-40%, about 40-50%, about 50-60%, about 60-70%,about 70-80%, about 80-90%, about 90-100%, about 1-25%, about 25-50%,about 50-75%, about 75-100%, at least about 0.5, at least about 1, atleast about 2, at least about 3, at least about 4, at least about 5,about 0.5-1, about 1-2, about 2-3, about 3-4, about 4-5, or about 5-6,e.g. as compared to placebo, or some other appropriate control(including an active control, such as a stimulant (e.g. methylphenidate,an amphetamine), modafanil, armodafanil, sodium oxybate, a tricyclicantidepressant, an SSRI, or an SNRI). This improvement may be observedat e.g. 1 week, 2 weeks, overall, or at any other relevant time, such as1 month, 6 months, 1 year, 2 years, etc. of the treatment withreboxetine.

In some embodiments, administering an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)may reduce the Hamilton Depression Rating Scale (HAM-D) score by atleast about 10%, at least about 20%, at least about 30%, at least about40%, at least about 50%, at least about 60%, at least about 70%, atleast about 80%, at least about 90%, at least about 95%, about 1-10%,about 10-20%, about 20-30%, about 30-40%, about 40-50%, about 50-60%,about 60-70%, about 70-80%, about 80-90%, about 90-100%, about 1-25%,about 25-50%, about 50-75%, or about 75-100%, at least about 1, at leastabout 2, at least about 3, at least about 4, at least about 5, at leastabout 6, at least about 7, at least about 8, at least about 9, at leastabout 10, at least about 11, at least about 12, at least about 13, atleast about 14, at least about 15, at least about 16, at least about 17,at least about 18, at least about 19, at least about 20, at least about21, at least about 22, at least about 23, at least about 30, at leastabout 40, about 1-2, about 2-3, about 3-4, about 4-5, about 5-6, about6-7, about 7-8, about 8-9, about 9-10, about 10-11, about 11-12, about12-13, about 13-14, about 14-15, about 15-16, about 16-17, about 17-18,about 18-19, about 19-20, about 20-21, about 21-22, about 22-23, about23-27, about 27-30, about 30-35, about 35-40, about 40-45, about 45-50,about 1-4, about 4-8, about 8-12, about 12-16, about 16-20, about 20-24,about 24-30, about 30-40, about 40-50. about 1-12, about 12-24, about24-36, or about 36-50 e.g. as compared to baseline, placebo, or someother appropriate control (including an active control, such as astimulant (e.g. methylphenidate, an amphetamine), modafanil,armodafanil, sodium oxybate, a tricyclic antidepressant, an SSRI, or anSNRI). This improvement may be observed at e.g. 1 week, 2 weeks,overall, or at any other relevant time, such as 1 month, 6 months, 1year, 2 years, etc. of the treatment with reboxetine.

In some embodiments, administering an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)may reduce nightmares or unpleasant dreams (such as frequent nightmaresand frequent unpleasant dreams) by at least about 1%, at least about10%, at least about 20%, at least about 30%, at least about 40%, atleast about 50%, at least about 60%, at least about 70%, at least about80%, at least about 90%, at least about 95%, about 1-10%, about 10-20%,about 20-30%, about 30-40%, about 40-50%, about 50-60%, about 60-70%,about 70-80%, about 80-90%, about 90-100%, about 1-25%, about 25-50%,about 50-75%, or about 75-100%, e.g. as compared to baseline, placebo,or some other appropriate control (including an active control, such asa stimulant (e.g. methylphenidate, an amphetamine), modafanil,armodafanil, sodium oxybate, a tricyclic antidepressant, an SSRI, or anSNRI). This improvement may be observed at e.g. 1 week, 2 weeks,overall, or at any other relevant time, such as 1 month, 6 months, 1year, 2 years, etc. of the treatment with reboxetine. A patient may beselected for treatment based upon having a problem with nightmares orunpleasant dreams (such as frequent nightmares and frequent unpleasantdreams), including nightmares or unpleasant dreams (such as frequentnightmares and frequent unpleasant dreams) associated with narcolepsy(with or without cataplexy).

In some embodiments, administering an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)may reduce hallucinations by at least about 1%, at least about 10%, atleast about 20%, at least about 30%, at least about 40%, at least about50%, at least about 60%, at least about 70%, at least about 80%, atleast about 90%, at least about 95%, about 1-10%, about 10-20%, about20-30%, about 30-40%, about 40-50%, about 50-60%, about 60-70%, about70-80%, about 80-90%, about 90-100%, about 1-25%, about 25-50%, about50-75%, or about 75-100%, e.g. as compared to baseline, placebo, or someother appropriate control (including an active control, such as astimulant (e.g. methylphenidate, an amphetamine), modafanil,armodafanil, sodium oxybate, a tricyclic antidepressant, an SSRI, or anSNRI). This improvement may be observed at e.g. 1 week, 2 weeks,overall, or at any other relevant time, such as 1 month, 6 months, 1year, 2 years, etc. of the treatment with reboxetine. A patient may beselected for treatment based upon having a problem with hallucinations,such as hallucinations associated with narcolepsy (with or withoutcataplexy).

In some embodiments, administering an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)may reduce sleep paralysis by at least about 1%, at least about 10%, atleast about 20%, at least about 30%, at least about 40%, at least about50%, at least about 60%, at least about 70%, at least about 80%, atleast about 90%, at least about 95%, about 1-10%, about 10-20%, about20-30%, about 30-40%, about 40-50%, about 50-60%, about 60-70%, about70-80%, about 80-90%, about 90-100%, about 1-25%, about 25-50%, about50-75%, or about 75-100%, e.g. as compared to baseline, placebo, or someother appropriate control (including an active control, such as astimulant (e.g. methylphenidate, an amphetamine), modafanil,armodafanil, sodium oxybate, a tricyclic antidepressant, an SSRI, or anSNRI). This improvement may be observed at e.g. 1 week, 2 weeks,overall, or at any other relevant time, such as 1 month, 6 months, 1year, 2 years, etc. of the treatment with reboxetine. A patient may beselected for treatment based upon having a problem with sleep paralysis,such as sleep paralysis associated with narcolepsy (with or withoutcataplexy).

In some embodiments, administering an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)may reduce disturbed nocturnal sleep by at least about 1%, at leastabout 10%, at least about 20%, at least about 30%, at least about 40%,at least about 50%, at least about 60%, at least about 70%, at leastabout 80%, at least about 90%, at least about 95%, about 1-10%, about10-20%, about 20-30%, about 30-40%, about 40-50%, about 50-60%, about60-70%, about 70-80%, about 80-90%, about 90-100%, about 1-25%, about25-50%, about 50-75%, or about 75-100%, e.g. as compared to baseline,placebo, or some other appropriate control (including an active control,such as a stimulant (e.g. methylphenidate, an amphetamine), modafanil,armodafanil, sodium oxybate, a tricyclic antidepressant, an SSRI, or anSNRI). This improvement may be observed at e.g. 1 week, 2 weeks,overall, or at any other relevant time, such as 1 month, 6 months, 1year, 2 years, etc. of the treatment with reboxetine. A patient may beselected for treatment based upon having a problem with disturbednocturnal sleep, such as disturbed nocturnal sleep associated withnarcolepsy (with or without cataplexy).

In some embodiments, administering an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)may reduce narcolepsy-related accidents by at least about 1%, at leastabout 10%, at least about 20%, at least about 30%, at least about 40%,at least about 50%, at least about 60%, at least about 70%, at leastabout 80%, at least about 90%, at least about 95%, about 1-10%, about10-20%, about 20-30%, about 30-40%, about 40-50%, about 50-60%, about60-70%, about 70-80%, about 80-90%, about 90-100%, about 1-25%, about25-50%, about 50-75%, or about 75-100%, e.g. as compared to baseline,placebo, or some other appropriate control (including an active control,such as a stimulant (e.g. methylphenidate, an amphetamine), modafanil,armodafanil, sodium oxybate, a tricyclic antidepressant, an SSRI, or anSNRI). This improvement may be observed at e.g. 1 week, 2 weeks,overall, or at any other relevant time, such as 1 month, 6 months, 1year, 2 years, etc. of the treatment with reboxetine. A patient may beselected for treatment based upon having a problem withnarcolepsy-related accidents (with or without cataplexy).

In some embodiments, administering an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)may reduce narcolepsy-related injuries by at least about 1%, at leastabout 10%, at least about 20%, at least about 30%, at least about 40%,at least about 50%, at least about 60%, at least about 70%, at leastabout 80%, at least about 90%, at least about 95%, about 1-10%, about10-20%, about 20-30%, about 30-40%, about 40-50%, about 50-60%, about60-70%, about 70-80%, about 80-90%, about 90-100%, about 1-25%, about25-50%, about 50-75%, or about 75-100%, e.g. as compared to baseline,placebo, or some other appropriate control (including an active control,such as a stimulant (e.g. methylphenidate, an amphetamine), modafanil,armodafanil, sodium oxybate, a tricyclic antidepressant, an SSRI, or anSNRI). This improvement may be observed at e.g. 1 week, 2 weeks,overall, or at any other relevant time, such as 1 month, 6 months, 1year, 2 years, etc. of the treatment with reboxetine.

In some embodiments, administering an antidepressant, including anorepinephrine inhibitor such as reboxetine (including S,S-reboxetine)may reduce narcolepsy-related fatal accidents by at least about 1%, atleast about 10%, at least about 20%, at least about 30%, at least about40%, at least about 50%, at least about 60%, at least about 70%, atleast about 80%, at least about 90%, at least about 95%, about 1-10%,about 10-20%, about 20-30%, about 30-40%, about 40-50%, about 50-60%,about 60-70%, about 70-80%, about 80-90%, about 90-100%, about 1-25%,about 25-50%, about 50-75%, or about 75-100%, e.g. as compared tobaseline, placebo, or some other appropriate control (including anactive control, such as a stimulant (e.g. methylphenidate, anamphetamine), modafanil, armodafanil, sodium oxybate, a tricyclicantidepressant, an SSRI, or an SNRI). This improvement may be observedat e.g. 1 week, 2 weeks, overall, or at any other relevant time, such as1 month, 6 months, 1 year, 2 years, etc. of the treatment withreboxetine. A patient may be selected for treatment based upon being atrisk for narcolepsy-related fatal accidents (for narcolepsy patientswith or without cataplexy).

Reboxetine (with the structure shown below) (including S,S-reboxetine,e.g. with the structure shown below) is a highly selective and potentnorepinephrine reuptake inhibitor that has the potential to address thekey symptoms of narcolepsy, such as cataplexy or EDS. Unlike existingtreatments for narcolepsy, reboxetine is not a controlled substance.Thus, the treatment with reboxetine would not be scheduled.

Unless otherwise indicated, any reference to a compound herein, such asreboxetine, by structure, name, or any other means, includespharmaceutically acceptable salts; free acids or bases; alternate solidforms, such as polymorphs, solvates, hydrates, etc.; tautomers;enantiomers; deuterium modified compounds, such as deuterium modifiedreboxetine; or any chemical species that may rapidly convert to acompound described herein under conditions in which the compounds areused as described herein.

In some embodiments, reboxetine is in a salt form, a free base form, ormay contain an excess (e.g. at least 60%, at least 70%, at least 80%, atleast 90%, at least 95%, at least 97%, or at least 99%) of(+)-reboxetine, also referred to as S,S-reboxetine or esreboxetine; oran excess (e.g. at least 60%, at least 70%, at least 80%, at least 90%,at least 95%, at least 97%, or at least 99%) of (−)-reboxetine.

For treatment of narcolepsy, the reboxetine (including S,S-reboxetine)may be administered in a manner that results in 1) a first local maximumin reboxetine (including S,S-reboxetine) plasma concentration and 2) asecond local maximum in reboxetine (including S,S-reboxetine) plasmaconcentration.

There are many potential ways that reboxetine (including S,S-reboxetine)could be administered in a manner that results in a first local maximumin reboxetine (including S,S-reboxetine) plasma concentration and asecond local maximum in reboxetine (including S,S-reboxetine) plasmaconcentration. A local maximum described herein is a maximum of a plasmaconcentration in a time period of interest in an individual patient,which is not necessarily the C_(max). The local maximum may be lower orthe same as C_(max). One potential way to administer reboxetine(including S,S-reboxetine) in a manner that results in a first localmaximum in reboxetine (including S,S-reboxetine) plasma concentrationand a second local maximum in reboxetine (including S,S-reboxetine)plasma concentration is to administer a first dosage form containingreboxetine (including S,S-reboxetine) and, at a later time, a seconddosage form containing reboxetine (including S,S-reboxetine). The dosesare administered at times that result in a first local maximum inreboxetine (including S,S-reboxetine) plasma concentration and a secondlocal maximum in reboxetine (including S,S-reboxetine) plasmaconcentration. For example, the second dosage form may be administeredless than half a day after the first dosage form, e.g. about 1-8 hours,about 8-12 hours, about 2-6 hours, about 1-2 hours, about 2-3 hours,about 3-4 hours, about 4-5 hours, about 5-6 hours, about 6-7 hours,about 7-8 hours, about 1-3 hours, about 2-4 hours, about 3-5 hours,about 4-6 hours, about 5-7 hours, about 6-8 hours, or about 7-10 hours,after the first dosage form, or any time period in a range bounded byany of these values.

Another method involves administering a single dosage form comprising afirst release component and a second release component. Both the firstrelease component and the second release component comprise reboxetine(including S,S-reboxetine).

In some embodiments, the first dosage form administered in a day, theonly dosage form administered during the day, or the first of two ormore dosage forms administered during the day, is administered shortlyafter waking, such as within about 3 hours, within about 2 hours, withinabout 1.5 hours, within about 1 hour, within about 30 minutes, or withinabout 15 minutes of waking from an overnight sleep.

For a single dosage form comprising a first release component and asecond release component that is administered in a day, the firstrelease component may release reboxetine (including S,S-reboxetine), maybegin releasing reboxetine (including S,S-reboxetine), or may result ina first local maximum in the plasma concentration of reboxetine(including S,S-reboxetine), about 0-30 minutes, about 30-60 minutes,about 60-90 minutes, or about 90-120 minutes after the dosage form isorally administered, or any time period in a range bounded by any ofthese values. The second release component may release reboxetine(including S,S-reboxetine) after the first release component releasesreboxetine (including S,S-reboxetine), or may cause an increase ofreboxetine (including S,S-reboxetine) plasma concentration or a secondlocal maximum in the plasma concentration of reboxetine (includingS,S-reboxetine), that is about 1-10 hours, about 2-6 hours, about 1-2hours, about 2-3 hours, about 3-4 hours, about 4-5 hours, about 5-6hours, about 6-7 hours, about 1-3 hours, about 2-4 hours, about 3-5hours, about 4-6 hours, about 5-7 hours, about 6-8 hours, or about 7-10hours after reboxetine (including S,S-reboxetine) is first released fromthe first release component, or after the first local maximum in theplasma concentration of reboxetine (including S,S-reboxetine), or at anytime in a range bounded by any of these values.

The first release component and the second release component may beincorporated into one single dosage form (such as a pill, tablet,capsule, caplet, or cachou). In one embodiment, the first releasecomponent would be located in one of the outer layers of the dosage formand the second release component would be located in one of the innerlayers of the same dosage form.

In another embodiment, the first release component is located in a firstlayer of the dosage form, and the second release component is located ina second layer of the same dosage form. The two layers are distinct andmay or may not be in contact with one another. In some embodiments, thetwo layers are stacked on top of one another and physically bound in abi-layer structure (e.g. where the largest surfaces of the two layerscontact one another, or the layers are thin compared to the otherdimensions of the layers). In some embodiments, the two layers arepositioned next to one another and physically bound in a bi-layerstructure (e.g. where the layers are thicker than other dimensions ofthe layers).

In another embodiment, the first release component and the secondrelease component may be constructed separately in their own specificgranules, particles, or the like, wherein the first release componentparticles are formulated to release reboxetine (includingS,S-reboxetine) before the second release component particles releasereboxetine (including S,S-reboxetine) and wherein both the first releasecomponent particles and the second release component particles arecombined together into a single dosage form, such as a capsule, pill,tablet, caplet, cachou or the like, and the two release components mayor may not be physically bound to one another.

In some embodiments, the first local maximum plasma concentration ofreboxetine (including S,S-reboxetine) occurs about 1-30 minutes, about30-60 minutes, about 1-2 hours, about 2-3 hours, or about 3-4 hoursafter the single dosage form or the first dosage form is administered,or at any time in a range bounded by any of these values. Generally, thesecond local maximum plasma concentration of reboxetine (includingS,S-reboxetine) occurs less than half a day after the first localmaximum plasma concentration of reboxetine (including S,S-reboxetine),such as about 1-10 hours, about 1-2 hours, about 2-6 hours, about 2-3hours, about 3-4 hours, about 4-5 hours, about 5-6 hours, about 6-7hours, about 7-8 hours, about 1-3 hours, about 2-4 hours, about 3-5hours, about 4-6 hours, about 5-7 hours, about 6-8 hours, or about 7-10hours, after the first local maximum plasma concentration of reboxetine(including S,S-reboxetine), or any time period in a range bounded by anyof these values.

For dosage forms containing a first release component and a secondrelease component, the first release component is associated with thefirst local maximum in reboxetine (including S,S-reboxetine) plasmaconcentration in that the first release component releases thereboxetine (including S,S-reboxetine) that contributes to the firstlocal maximum in reboxetine (including S,S-reboxetine) plasmaconcentration. For example, the first release component could releasereboxetine (including S,S-reboxetine) faster or sooner than the secondrelease component, so that most of the reboxetine (includingS,S-reboxetine) contributing to the first local maximum plasmaconcentration of reboxetine (including S,S-reboxetine) that was releasedfrom the first release component.

For dosage forms containing a first release component and a secondrelease component, the second release component is associated with thesecond local maximum in reboxetine (including S,S-reboxetine) plasmaconcentration in that the second release component releases thereboxetine (including S,S-reboxetine) that contributes to the secondlocal maximum in reboxetine (including S,S-reboxetine) plasmaconcentration. For example, the second release component could delayrelease of its reboxetine (including S,S-reboxetine) so that at a timewhen the reboxetine (including S,S-reboxetine) plasma concentration isdecreasing after the first local maximum, the second release componentreleases a sufficient amount of reboxetine (including S,S-reboxetine) toagain increase the plasma concentration of reboxetine (includingS,S-reboxetine) so that the second local maximum in reboxetine(including S,S-reboxetine) plasma concentration is achieved.

For dosage forms containing a first release component and a secondrelease component, any suitable amount of reboxetine (includingS,S-reboxetine) may be present in the first release component, such asabout 1-10 mg, about 0.1-2 mg, about 0.5-1.5 mg, about 1-2 mg, about1.5-2.5 mg, about 2-3 mg, about 2.5-3.5 mg, about 3-4 mg, about 3.5-4.5mg, about 4-5 mg, about 4.5-5.5 mg, about 5-6 mg, about 6-7 mg, about7-8 mg, about 8-9 mg, about 9-10 mg, about 1-3 mg, about 2-4 mg, about3-5 mg, about 4-6 mg, about 5-7 mg, about 7-10 mg, about 4 mg, about 5mg, about 0.0003-0.006 mmol, about 0.006-0.009 mmol, about 0.009-0.012mmol, about 0.012-0.015 mmol, about 0.015-0.018 mmol, about 0.018-0.021mmol, about 0.021-0.024 mmol, about 0.024-0.027 mmol, about 0.027-0.03mmol, about 0.03-0.033 mmol, or any amount in a range bounded by any ofthese values.

For dosage forms containing a first release component and a secondrelease component, any suitable amount of reboxetine (includingS,S-reboxetine) may be present in the second release component, such asabout 0.1-2 mg, about 0.5-1.5 mg, about 1-3 mg, about 1-2 mg, about1.5-2.5 mg, about 2-3 mg, about 2.5-3.5 mg, about 3-4 mg, about 2-4 mg,about 3-5 mg, about 3.5-4.5 mg, about 4-5 mg, about 4.5-5.5 mg, about5-6 mg, about 4-6 mg, about 6-7 mg, about 7-8 mg, about 8-9 mg, about9-10 mg, about 5-7 mg, about 7-10 mg, about 4 mg, about 5 mg, about0.0003-0.006 mmol, about 0.006-0.009 mmol, about 0.009-0.012 mmol, about0.012-0.015 mmol, about 0.015-0.018 mmol, about 0.018-0.021 mmol, about0.021-0.024 mmol, about 0.024-0.027 mmol, about 0.027-0.03 mmol, about0.03-0.033 mmol, or any amount in a range bounded by any of thesevalues.

In some embodiments, the first release component may contain morereboxetine (including S,S-reboxetine) than the second release component,such as about 10-20% more, about 20-30% more, or about 30-40% morereboxetine (including S,S-reboxetine), than the second releasecomponent.

While the dosing schedules given above may be useful in many situations,the daily dosing schedule may be different than described above. Forexample, a once a day dose may be administered. A twice daily dose maybe administered in any suitable way, such as in the morning and theevening, in a manner described above, or some other way.

In some embodiments, the daily dose of reboxetine (includingS,S-reboxetine), may be about 0.5-1 mg, about 1-1.5 mg, about 1.5-2 mg,about 1-2 mg, about 2-3 mg, about 3-4 mg, about 4-5 mg, about 5-6 mg,about 6-7 mg, about 7-8 mg, about 8-9 mg, about 9-10 mg, about 10-11 mg,about 11-12 mg, about 12-13 mg, about 13-14 mg, about 14-15 mg, about15-16 mg, about 16-17 mg, about 2-5 mg, about 5-8 mg, about 8-11 mg,about 11-14 mg, about 14-17 mg, about 17-20 mg, about 8-10 mg, about8-12 mg, about 0.0015-0.003 mmol, about 0.003-0.0045 mmol, about0.0045-0.006 mmol, about 0.003-0.006 mmol, about 0.006-0.009 mmol, about0.009-0.012 mmol, about 0.012-0.015 mmol, about 0.015-0.018 mmol, about0.018-0.021 mmol, about 0.021-0.024 mmol, about 0.024-0.027 mmol, about0.027-0.03 mmol, about 0.03-0.033 mmol, about 0.033-0.036 mmol, about0.036-0.039 mmol, about 0.039-0.042 mmol, about 0.042-0.045 mmol, about0.045-0.048 mmol, about 0.048-0.051 mmol, about 0.051-0.054 mmol, about0.054-0.057 mmol, about 0.057-0.06 mmol, about 0.06-0.063 mmol, about0.063-0.066 mmol, about 0.066-0.069 mmol, about 0.006-0.01 mmol, about0.01-0.02 mmol, about 0.02-0.03 mmol, about 0.03-0.04 mmol, about0.04-0.05 mmol, about 0.05-0.06 mmol, about 0.06-0.07 mmol, or about0.07-0.08 mmol. The daily dose is the total amount of reboxetineadministered in a single day. The daily dose may be administered for atleast about 1 week, at least about 2 weeks, at least about 3 weeks, atleast about 4 weeks, at least about 5 weeks, at least about 6 weeks, atleast about 7 weeks, at least about 8 weeks, at least about 9 weeks, atleast about 10 weeks, at least about 11 weeks, at least about 12 weeks,at least 4 months, at least 5 months, at least about 6 months, at leastabout 7 months, at least about 8 months, at least about 9 months, atleast about 10 months, at least about 11 months, at least about 12months, at least 1.5 years, at least 2 years, at least about 3 years, atleast about 4 years, at least about 5 years, at least about 10 years, atleast about 20 years, or longer. In some embodiments, the daily dose isadministered for up to about 6 months, up to about 1 year, up to about 2years, up to about 5 years, up to about 10 years, up to about 20 years,up to about 40 years, up to about 60 years, or up to about 90 years.

The dose of reboxetine (including S,S-reboxetine) may gradually increaseover time, such as for 1, 2, 3, 4, 5, 6, or 7 days, to a maintenancedose, which is a total dose given each day (e.g. a 10 mg maintenancedose could be a once daily 10 mg dose, a 6 mg morning dose and a 4 mgafternoon dose, or 5 mg given twice a day for a total of 10 mg per day).In some embodiments, the maintenance dose may be 2-3 mg, about 3-4 mg,about 4-5 mg, about 5-6 mg, about 6-7 mg, about 7-8 mg, about 8-9 mg,about 9-10 mg, about 10-11 mg, about 11-12 mg, about 12-13 mg, about13-14 mg, about 14-15 mg, about 15-16 mg, about 16-17 mg, about 2-5 mg,about 5-8 mg, about 8-11 mg, about 11-14 mg, about 14-17 mg, about 17-20mg, about 8-10 mg, about 8-12 mg, about 0.006-0.009 mmol, about0.009-0.012 mmol, about 0.012-0.015 mmol, about 0.015-0.018 mmol, about0.018-0.021 mmol, about 0.021-0.024 mmol, about 0.024-0.027 mmol, about0.027-0.03 mmol, about 0.03-0.033 mmol, about 0.033-0.036 mmol, about0.036-0.039 mmol, about 0.039-0.042 mmol, about 0.042-0.045 mmol, about0.045-0.048 mmol, about 0.048-0.051 mmol, about 0.051-0.054 mmol, about0.054-0.057 mmol, about 0.057-0.06 mmol, about 0.06-0.063 mmol, about0.063-0.066 mmol, about 0.066-0.069 mmol, about 0.006-0.01 mmol, about0.01-0.02 mmol, about 0.02-0.03 mmol, about 0.03-0.04 mmol, about0.04-0.05 mmol, about 0.05-0.06 mmol, about 0.06-0.07 mmol, or about0.07-0.08 mmol. In some embodiments, a first dose, e.g. administered inthe morning, may contain more reboxetine (including S,S-reboxetine) thana second dose administered in a day, e.g. administered in the afternoon.For example, the first dose of the day, e.g. administered in themorning, may have about 10-20% more, about 20-30% more, or about 30-40%more reboxetine (including S,S-reboxetine) than the second dose of theday, e.g. administered in the afternoon. The maintenance dose may beadministered for at least about 1 week, at least about 2 weeks, at leastabout 3 weeks, at least about 4 weeks, at least about 5 weeks, at leastabout 6 weeks, at least about 7 weeks, at least about 8 weeks, at leastabout 9 weeks, at least about 10 weeks, at least about 11 weeks, atleast about 12 weeks, at least 4 months, at least 5 months, at leastabout 6 months, at least about 7 months, at least about 8 months, atleast about 9 months, at least about 10 months, at least about 11months, at least about 12 months, at least 1.5 years, at least 2 years,at least about 3 years, at least about 4 years, at least about 5 years,at least about 10 years, at least about 20 years, or longer. In someembodiments, the maintenance dose is administered for up to about 6months, up to about 1 year, up to about 2 years, up to about 5 years, upto about 10 years, up to about 20 years, up to about 40 years, up toabout 60 years, or up to about 90 years.

In some embodiments, a patient receives about 110-130 mg of reboxetine(including S,S-reboxetine) over a period of two weeks.

In some embodiments, the first release component provides immediaterelease of reboxetine (including S,S-reboxetine). In some embodiments,the first release component provides delayed release of reboxetine(including S,S-reboxetine). In some embodiments, the first releasecomponent provides sustained release of reboxetine (includingS,S-reboxetine).

In some embodiments, the second release component provides immediaterelease of reboxetine (including S,S-reboxetine). In some embodiments,the second release component provides delayed release of reboxetine(including S,S-reboxetine). In some embodiments, the second releasecomponent provides sustained release of reboxetine (includingS,S-reboxetine).

In some embodiments, the first release component provides immediaterelease of reboxetine (including S,S-reboxetine), and the second releasecomponent provides delayed release of reboxetine (includingS,S-reboxetine). In some embodiments, the first release componentprovides immediate release of reboxetine (including S,S-reboxetine), andthe second release component provides sustained release of reboxetine(including S,S-reboxetine).

With respect to methods wherein the reboxetine (includingS,S-reboxetine) is administered in a first dosage form containingreboxetine (including S,S-reboxetine) and a second dosage formcontaining reboxetine (including S,S-reboxetine), any suitable amount ofreboxetine (including S,S-reboxetine) may be present in the first dosageform, such as about 1-10 mg, about 0.1-1 mg, about 0.1-2 mg, about0.5-1.5 mg, about 1-3 mg, about 1-2 mg, about 1.5-2.5 mg, about 2-3 mg,about 2.5-3.5 mg, about 3-4 mg, about 3.5-4.5 mg, about 4-5 mg, about4.5-5.5 mg, about 5-6 mg, about 6-7 mg, about 7-8 mg, about 8-9 mg,about 9-10 mg, about 2-4 mg, about 3-5 mg, about 4-6 mg, about 5-7 mg,about 7-10 mg, about 4 mg, about 5 mg, about 0.0003-0.006 mmol, about0.006-0.009 mmol, about 0.009-0.012 mmol, about 0.012-0.015 mmol, about0.015-0.018 mmol, about 0.018-0.021 mmol, about 0.021-0.024 mmol, about0.024-0.027 mmol, about 0.027-0.03 mmol, about 0.03-0.033 mmol, or anyamount in a range bounded by any of these values.

With respect to methods wherein the reboxetine (includingS,S-reboxetine) is administered in a first dosage form containingreboxetine (including S,S-reboxetine) and a second dosage formcontaining reboxetine (including S,S-reboxetine), any suitable amount ofreboxetine (including S,S-reboxetine) may be present in the seconddosage form, such as about 0.1-1 mg, about 0.1-2 mg, about 0.5-1.5 mg,about 1-3 mg, about 1-2 mg, about 1.5-2.5 mg, about 2-3 mg, about2.5-3.5 mg, about 3-4 mg, about 3.5-4.5 mg, about 4-5 mg, about 4.5-5.5mg, about 5-6 mg, about 6-7 mg, about 7-8 mg, about 8-9 mg, about 9-10mg, about 2-4 mg, about 3-5 mg, about 4-6 mg, about 5-7 mg, about 7-10mg, about 4 mg, about 5 mg, about 0.0003-0.006 mmol, about 0.006-0.009mmol, about 0.009-0.012 mmol, about 0.012-0.015 mmol, about 0.015-0.018mmol, about 0.018-0.021 mmol, about 0.021-0.024 mmol, about 0.024-0.027mmol, about 0.027-0.03 mmol, about 0.03-0.033 mmol, or any amount in arange bounded by any of these values.

In some embodiments, the first dosage form may contain more reboxetine(including S,S-reboxetine) than the dosage form, such as about 10-20%more, about 20-30% more, or about 30-40% more reboxetine (includingS,S-reboxetine) than the second dosage form.

In some embodiments, the first dosage form provides immediate release ofreboxetine (including S,S-reboxetine). In some embodiments, the firstdosage form provides delayed release of reboxetine (includingS,S-reboxetine). In some embodiments, the first dosage form providessustained release of reboxetine (including S,S-reboxetine).

In some embodiments, the second dosage form provides immediate releaseof reboxetine (including S,S-reboxetine). In some embodiments, thesecond dosage form provides delayed release of reboxetine (includingS,S-reboxetine). In some embodiments, the second dosage form providessustained release of reboxetine (including S,S-reboxetine).

With respect to single dosage forms containing both a first releasecomponent and a second release component, in some embodiments, thesingle dosage is administered within two hours of waking from anovernight sleep.

For some embodiments wherein more than one dosage form is given, thefirst dosage form may be administered within two hours of waking from anovernight sleep.

There are many factors that can affect the overall time required for adrug substance such as reboxetine (including S,S-reboxetine) to be fullyabsorbed and/or reach a maximum plasma concentration in a human being.Some of these factors include a human patient's age, weight, gender,level of stress, stomach contents, stomach pH level, and the presence ofother medications. The time required to reach a maximum plasmaconcentration of the drug such as reboxetine (including S,S-reboxetine)may also be affected by the time of the day taken the drug such asreboxetine (including S,S-reboxetine) and the level of physical activityof the human patient. Another factor that can affect the time requiredto reach a maximum plasma concentration of the drug such as reboxetine(including S,S-reboxetine) is the presence or absence of a controlledrelease coating on the drug such as reboxetine (includingS,S-reboxetine).

Controlled release includes: immediate release of drug substance such asreboxetine (including S,S-reboxetine) at a certain time or in a certainarea of the body; delayed release of a drug substance; sustained releaseof drug substance at a certain time or place in the body; or an extendedrelease of a drug substance such as reboxetine (includingS,S-reboxetine).

Reboxetine (including S,S-reboxetine) is normally rapidly absorbed inhuman patients, reaching a maximum plasma concentration in about 2-4hours. To achieve a delay in the time required to reach a maximum plasmaconcentration, a controlled release coating or mixture may be employed.

Delayed release is a general drug delivery term that describes the formof an oral medication that does not immediately discharge its activedrug component in the mouth or in the stomach of a patient. While theremay be many ways to achieve delayed release, delayed release ofreboxetine (including S,S-reboxetine) may be achieved by completely orpartially surrounding the reboxetine (including S,S-reboxetine), e.g. inthe second release component, with a coating or layer (e.g. an innercontrolled release coating) that does not immediately dissolve whenswallowed. For example, the material of the coating or layer may slowlydissolve in the stomach, and/or slowly disintegrate by chemicalreaction, such as by hydrolysis, in the stomach until the layer can nolonger prevent the reboxetine (including S,S-reboxetine) from cominginto contact with the gastric fluid.

In some embodiments, the delayed release coating ensures deliverythrough the stomach and into the intestines. Once in the duodenum, thecoating may begin to break down and begin to release reboxetine(including S,S-reboxetine). In some cases, the reboxetine (includingS,S-reboxetine) may be completely released in the duodenum. In someembodiments, the reboxetine (including S,S-reboxetine) may be partiallyreleased in the duodenum, and partially released in the jejunum. In somecases, the reboxetine (including S,S-reboxetine) may be completelyreleased in the jejunum. In some cases, the reboxetine (includingS,S-reboxetine) may be partially released in the jejunum and partiallyreleased in the ilium. In some cases, the reboxetine (includingS,S-reboxetine) may be completely released in the ilium. In some cases,the reboxetine (including S,S-reboxetine) may be partially released inthe duodenum, the jejunum, and the ilium. In some embodiments, thereboxetine (including S,S-reboxetine) may be partially released in theilium, and partially released in the colon. In some cases, thereboxetine (including S,S-reboxetine) may be completely released in thecolon.

The time of the delayed release, e.g. between release of the firstreboxetine (including S,S-reboxetine) component and the secondreboxetine (including S,S-reboxetine) component, can be adjusted byusing a material that dissolves or disintegrates more or less slowly inthe digestive system, adjusting the thickness of the coating layer orthe coating material (e.g. a thicker layer would provide a longer time),and/or by using materials whose properties are sensitive to pH. Forexample, materials that are less stable to, or more soluble in, acidicpHs, may dissolve or disintegrate more quickly in the stomach becausethe stomach pH is lower than the pH in the intestines. Conversely,materials that are stable at low pH, but less stable at higher pH maydissolve or disintegrate later because of the time it takes the dosageform to travel through the gastrointestinal tract.

A controlled release formulation containing reboxetine (includingS,S-reboxetine) can be coated with one or more functional ornon-functional coatings. Examples of functional coatings includecontrolled release polymeric coatings (i.e. controlled release coats),moisture barrier coatings, enteric polymeric coatings, and the like.

A controlled release polymer may be used for both sustained release orfor delayed release, depending upon the structure of the dosage form.For example, interspersing the reboxetine (including S,S-reboxetine)throughout a controlled release polymer can provide sustained release,since the drug will be released for as long as the polymer is present inthe GI tract. Delayed release may be achieved by creating a barrier,such as a coating, which is intended to last for a shorter time (e.g.less than 12 hours, less than 10 hours, less than 6 hours, less than 3hours, etc.), so that when the barrier is penetrated, the reboxetine(including S,S-reboxetine) is freely released. The thickness of thebarrier can be used to control the delay time.

Any suitable controlled release polymer may be used, such as acrylicacid and methacrylic acid copolymers and various esters thereof, e.g.methyl methacrylate copolymers, ethoxyethyl methacrylates, cyanoethylmethacrylate, aminoalkyl methacrylate copolymer, poly(acrylic acid),poly(methacrylic acid), methacrylic acid alkylamine copolymer,poly(methyl methacrylate), poly(methacrylic acid) (anhydride),polyacrylamide, poly(methacrylic acid anhydride), and glycidylmethacrylate copolymers.

Other suitable controlled release polymers include polymerizablequaternary ammonium compounds, e.g. quaternized aminoalkyl esters andaminoalkyl amides of acrylic acid and methacrylic acid, for exampleβ-methacryloxyethyltrimethylammonium methosulfate,β-acryloxypropyltrimethylammonium chloride, andtrimethylaminomethylmethacrylamide methosulfate. The quaternary ammoniumatom can also be part of a heterocycle, as inmethacryloxyethylmethylmorpholinium chloride or the correspondingpiperidinium salt, or it can be joined to an acrylic acid group or amethacrylic acid group by way of a group containing hetero atoms, suchas a polyglycol ether group. Further suitable polymerizable quaternaryammonium compounds include quaternized vinyl-substituted nitrogenheterocycles such as methyl-vinyl pyridinium salts, vinyl esters ofquaternized amino carboxylic acids, styryltrialkyl ammonium salts, andthe like. Other polymerizable quaternary ammonium compounds includebenzyldimethylammoniumethylmethacrylate chloride,diethylmethylammoniumethyl-acrylate and -methacrylate methosulfate,N-trimethylammoniumpropylmethacrylamide chloride, andN-trimethylammonium-2,2-dimethylpropyl-1-methacrylate chloride.

Delayed release may also be achieved by using a controlled releasepolymer that targets a particular pH, with the understanding that, withproper fasting or feeding, the particular pH could correspond to aparticular time after administration.

For some controlled release polymers, an acrylic or methacrylic polymercomprises one or more ammonio methacrylate copolymers. Ammoniomethacrylate copolymers (such as those sold by Evonik under thetrademark EUDRAGIT® RS and RL) are fully polymerized copolymers ofacrylic and methacrylic acid esters with a low content of quaternaryammonium groups. The ammonium groups are appended to the ester portionof the methacrylate (as 2-trimethylammonium-ethyl esters). The chargedammonium groups in these polymers make them insoluble and highlypermeable with pH-independent swelling. These properties make thesepolymers useful for customized, time-controlled release of the coateddrug. In order to obtain a desirable dissolution profile for a giventherapeutically active agent, such as reboxetine (includingS,S-reboxetine), two or more ammonio methacrylate copolymers havingdiffering physical properties can be incorporated. For example, it isknown that by changing the molar ratio of the pre-polymerized materialscontaining quaternary ammonium groups to pre-polymerized materialscontaining the uncharged, neutral methacrylic or acrylic esters, thepermeability properties of the resultant coating can be modified.

In other embodiments, the control releasing coat further includes apolymer whose permeability is pH dependent, such as anionic polymerssynthesized from methacrylic acid and methacrylic acid methyl ester.Such polymers are commercially available, e.g., from Evonik, under thetradename EUDRAGIT® L and EUDRAGIT® S. The ratio of free carboxyl groupsto the esters is known to be 1:1 in EUDRAGIT® L and 1:2 in EUDRAGIT® S.EUDRAGIT® L is insoluble in acids and pure water but becomesincreasingly permeable above pH 5.0. This makes EUDRAGIT® L appropriatefor targeting release of the coated drug substance such as coatedreboxetine (including S,S-reboxetine) in the duodenum and the jejunum ofthe small intestine. Thus, a EUDRAGIT® L coated drug substance mayachieve a delay in maximum plasma concentration, relative to an uncoatedor immediate release drug substance (e.g. reboxetine (includingS,S-reboxetine) in a first release component), of about 30 min to about1 hour, about 1-1.5 hours, about 1.5-2 hours, about 2-2.5 hours, about2.5-3 hours, or about 3.5-4 hours.

EUDRAGIT® S is similar to EUDRAGIT® L, except that it becomesincreasingly permeable above pH 7. This makes EUDRAGIT® S appropriatefor targeting release of the coated drug substance such as coatedreboxetine (including S,S-reboxetine) in the ileum of the smallintestine and also the colon. Thus, a EUDRAGIT® S coated drug substancemay achieve a delay in maximum plasma concentration, relative to anuncoated or immediate release drug substance (e.g. reboxetine (includingS,S-reboxetine) in a first release component), of about 1-2 hours, about2-3 hours, about 3-4 hours about 4-5 hours, about 5-6 hours, about 6-7hours, about 7-8 hours, about 8-9 hours, or about 9-10 hours.

A hydrophobic acrylic polymer coating can also include a polymer whichis based on dimethylaminoethyl methacrylate and neutral methacrylic acidesters (such as EUDRAGIT® E, commercially available from Evonik).EUDRAGIT® E is not soluble in saliva (making it useful for taste andodor masking) but is soluble in gastric fluid with pH 5 or less, whichprovides an immediate release of drug product in the stomach. Reboxetine(including S,S-reboxetine) surrounded with a EUDRAGIT® E coating mayrelease reboxetine (including S,S-reboxetine), may begin releasingreboxetine (including S,S-reboxetine), or may reach a first localmaximum in the plasma concentration of reboxetine (includingS,S-reboxetine), at a time of about 0-30 minutes, 30-60 minutes, 60-90minutes, or 90-120 minutes after the dosage form is orally administered,or any time period in a range bounded by any of these values.

A hydrophobic acrylic polymer coating can include a neutral copolymerbased on a poly methacrylate, such as EUDRAGIT® NE (NE=neutral ester),commercially available from Evonik. EUDRAGIT® NE 30D lacquer films areinsoluble in water and digestive fluids, but permeable and swellable,providing another option for time-controlled release. EUDRAGIT® NE has apH-independent sustained release effect that can release a drugsubstance such as reboxetine (including S,S-reboxetine) over a period oftime, or may delay release for a period of time, wherein the time ofrelease or delay is about 1-24 hours, about 1-18 hours, about 1-12hours, about 1-8 hours, or about 1-6 hours.

In some embodiments, the control releasing coat comprises a polymercomprising ethyl acrylate and methyl methacrylate in a 2:1 ratio(KOLLICOAT® EMM 30 D, BASF). KOLLICOAT® EMM 30 D has a pH-independentsustained release effect that can release a drug substance such asreboxetine (including S,S-reboxetine) over a period of time, or maydelay release for a period of time, wherein the time of release or delayis about 1-24 hours, about 1-18 hours, about 1-12 hours, about 1-8hours, or about 1-6 hours.

In some embodiments, the control releasing coat comprises a polyvinylacetate stabilized with polyvinylpyrrolidone and sodium lauryl sulfatesuch as KOLLICOAT® SR30D (BASF). The dissolution profile can be alteredby changing the relative amounts of different acrylic resin lacquersincluded in the coating. Also, by changing the molar ratio ofpolymerizable permeability-enhancing agent (e.g., the quaternaryammonium compounds) to the neutral methacrylic esters, the permeabilityproperties (which affect the dissolution profile) of the resultantcoating can be modified. KOLLICOAT® SR30D is another coating with apH-independent sustained release effect that can release a drugsubstance such as reboxetine (including S,S-reboxetine) over a period oftime, or may delay release for a period of time, wherein the time ofrelease or delay is about 1-24 hours, about 1-18 hours, about 1-12hours, about 1-8 hours, about 1-6 hours, about 1-4 hours, or about 1-2hours.

In some embodiments, the control releasing coat comprisesethylcellulose, which can be used as a dry polymer (such as ETHOCEL™,Dow Chemical Company) solubilized in organic solvent prior to use, or asan aqueous dispersion. One suitable commercially-available aqueousdispersion of ethylcellulose is Aquacoat® (Danisco). Aquacoat® ECD(ethylcellulose aqueous dispersion), Aquacoat® ARC (alcohol-resistantethylcellulose aqueous dispersion), and Aquacoat® CPD (cellulose acetatephthalate aqueous dispersion) are all commercially available controlledrelease coatings. Another suitable aqueous dispersion of ethylcelluloseis commercially available as Surelease® (Colorcon, Inc.). This productcan be prepared by incorporating plasticizer into the dispersion duringthe manufacturing process. A hot melt of a polymer, plasticizer (e.g.dibutyl sebacate), and stabilizer (e.g. oleic acid) may be mixed andprepared as a homogeneous mixture, which is then diluted with analkaline solution to obtain an aqueous dispersion which can be applieddirectly onto substrates. These coatings have a pH-independent sustainedrelease effect that can release a drug substance such as reboxetine(including S,S-reboxetine) over a period of time, or may delay releasefor a period of time, wherein the time of release or delay is about 1-24hours, about 1-18 hours, about 1-12 hours, about 1-8 hours, about 1-6hours, about 1-4 hours, or about 1-2 hours.

Other examples of polymers that can be used in the control-releasingcoat include cellulose acetate phthalate, cellulose acetate trimaleate,hydroxypropyl methylcellulose phthalate, hydroxypropyl methylcelluloseacetate succinate, polyvinyl alcohol phthalate, shellac, hydrogels andgel-forming materials, such as carboxyvinyl polymers, sodium alginate,sodium carmellose, calcium carmellose, sodium carboxymethyl starch, polyvinyl alcohol, hydroxyethyl cellulose, methyl cellulose, ethylcellulose, gelatin, starch, and cellulose based cross-linked polymers inwhich the degree of crosslinking is low so as to facilitate adsorptionof water and expansion of the polymer matrix, hydroxypropyl cellulose,hydroxypropyl methylcellulose, polyvinylpyrrolidone, crosslinked starch,microcrystalline cellulose, chitin, pullulan, collagen, casein, agar,gum arabic, sodium carboxymethyl cellulose, (swellable hydrophilicpolymers) poly(hydroxyalkyl methacrylate) (molecular weight 5 k to 5000k), polyvinylpyrrolidone (molecular weight 10 k to 360 k), anionic andcationic hydrogels, zein, polyamides, polyvinyl alcohol having a lowacetate residual, a swellable mixture of agar and carboxymethylcellulose, copolymers of maleic anhydride and styrene, ethylene,propylene or isobutylene, pectin (molecular weight 30 k to 300 k),polysaccharides such as agar, acacia, karaya, tragacanth, algins andguar, polyacrylamides, POLYOX® polyethylene oxides (molecular weight 100k to 5000 k, Dow), AQUA KEEP® acrylate polymers (composed of mainlyacrylic acid polymer, sodium salt), diesters of polyglucan, crosslinkedpolyvinyl alcohol and poly N-vinyl-2-pyrrolidone, hydrophilic polymerssuch as polysaccharides, methyl cellulose, sodium or calciumcarboxymethyl cellulose, hydroxypropyl methyl cellulose, hydroxypropylcellulose, hydroxyethyl cellulose, nitro cellulose, carboxymethylcellulose, cellulose ethers, methyl ethyl cellulose, ethylhydroxyethylcellulose, cellulose acetate, cellulose butyrate, cellulosepropionate, gelatin, starch, maltodextrin, pullulan, polyvinylpyrrolidone, polyvinyl alcohol, polyvinyl acetate, glycerol fatty acidesters, polyacrylamide, polyacrylic acid, natural gums, lecithins,pectin, alginates, ammonia alginate, sodium, calcium, potassiumalginates, propylene glycol alginate, agar, and gums such as arabic,karaya, locust bean, tragacanth, carrageenan, guar, xanthan,scleroglucan and mixtures and blends thereof.

In some embodiments, the dosage forms of reboxetine (includingS,S-reboxetine) are coated with polymers in order to facilitatemucoadhesion within the gastrointestinal tract. Non-limiting examples ofpolymers that can be used for mucoadhesion includecarboxymethylcellulose, polyacrylic acid, Carbopol™ (Lubrizol),polycarbophil, gelatin and other natural or synthetic polymers.

The polymeric coatings of the present disclosure may be any one of thedescribed coatings or may be a combination of two or more of thedescribed coatings to achieve the desired release profiles of therelease of reboxetine (including S,S-reboxetine).

In addition to the modified release dosage forms described herein, othermodified release technologies known to those skilled in the art can beused in order to achieve the modified release formulations of thepresent disclosure, i.e., formulations which provide a mean T_(max) ofthe drug and/or other pharmacokinetic parameters described herein whenadministered e.g., orally or by other mode of administration to humanpatients. Such formulations can be manufactured as a modified releaseoral formulation in a suitable tablet or multiparticulate formulationknown to those skilled in the art. In either case, the modified releasedosage form can optionally include a controlled release carrier which isincorporated into a matrix along with the drug, or which is applied as acontrolled release coating.

Any dosage form comprising an effective amount of reboxetine (includingS,S-reboxetine) may further comprise a binder, a lubricant, and otherconventional inert excipients.

A binder (also sometimes called adhesive) can be added to a drug-fillermixture to increase the mechanical strength of the granules and tabletsduring formation. Binders can be added to the formulation in differentways: (1) as a dry powder, which is mixed with other ingredients beforewet agglomeration, (2) as a solution, which is used as agglomerationliquid during wet agglomeration, and is referred to as a solutionbinder, and (3) as a dry powder, which is mixed with the otheringredients before compaction. In this form the binder is referred to asa dry binder. Solution binders are a common way of incorporating abinder into granules. In certain embodiments, the binder used in thetablets is in the form of a solution binder. Non-limiting examples ofbinders useful include hydrogenated vegetable oil, castor oil, paraffin,higher aliphatic alcohols, higher aliphatic acids, long chain fattyacids, fatty acid esters, wax-like materials such as fatty alcohols,fatty acid esters, fatty acid glycerides, hydrogenated fats,hydrocarbons, normal waxes, stearic acid, stearyl alcohol, hydrophobicand hydrophilic polymers having hydrocarbon backbones, and mixturesthereof. Specific examples of water-soluble polymer binders includemodified starch, gelatin, polyvinylpyrrolidone, cellulose derivatives(e.g. hydroxypropyl methylcellulose (HPMC) and hydroxypropyl cellulose(HPC)), polyvinyl alcohol and mixtures thereof. Any suitable amount ofbinder may be present, such as about 0.5-5%, about 5-10%, about 10-15%,about 15-20%, about 20-25%, about 0.5-25%, about 0.5-15%, about 1-6%, orabout 3% by weight of the tablet dry weight. In some embodiments, thebinder is polyvinyl alcohol.

Lubricants can be added to pharmaceutical formulations to decrease anyfriction that occurs between the solid and the die wall during tabletmanufacturing. High friction during tableting can cause a series ofproblems, including inadequate tablet quality (capping or evenfragmentation of tablets during ejection, and vertical scratches ontablet edges) and may even stop production. Accordingly, lubricants maybe added to tablet formulations. Non-limiting examples of lubricantsuseful include glyceryl behenate, stearic acid, hydrogenated vegetableoils (such as hydrogenated cottonseed oil (STEROTEX®, hydrogenatedsoybean oil (STEROTEX® HM) and hydrogenated soybean oil & castor wax(STEROTEX® K), stearyl alcohol, leucine, polyethylene glycol (MW 1450,suitably 4000, and higher), magnesium stearate, glyceryl monostearate,stearic acid, polyethylene glycol, ethylene oxide polymers (for example,available under the registered trademark CARBOWAX® from Union Carbide,Inc., Danbury, Conn.), sodium lauryl sulfate, magnesium lauryl sulfate,sodium oleate, sodium stearyl fumarate, DL-leucine, colloidal silica,mixtures thereof and others as known in the art. In some embodiments,the lubricant is glyceryl behenate (for example, COMPRITOL® 888). Anysuitable amount of binder may be present, such as about 0.5-5%, about5-10%, about 10-15%, about 15-20%, about 20-25%, about 0.5-25%, about0.5-15%, about 1-6%, or about 3% by weight of the tablet dry weight.

In some embodiments, reboxetine (including S,S-reboxetine) isadministered once a day or twice a day for at least about 3 weeks, atleast about 4 weeks, at least about 5 weeks, at least about 6 weeks, atleast about 7 weeks, at least about 8 weeks, at least about 9 weeks, atleast about 10 weeks, at least about 11 weeks, at least about 12 weeks,at least about 4 months, at least about 5 months, at least about 6months, at least about 7 months, at least about 8 months, at least about9 months, at least about 10 months, at least about 11 months, at leastabout 12 months, at least 1.5 years, at least 2 years, at least about 3years, at least about 4 years, at least about 5 years, about 0.1-5years, about 5-10 years, at least about 10 years, about 10-15 years, atleast about 15 years, about 15-20 years, at least about 20 years, orlonger. In some embodiments, reboxetine (including S,S-reboxetine) isadministered for up to about 6 months, up to about 1 year, up to about 2years, up to about 5 years, up to about 10 years, up to about 20 years,up to about 40 years, up to about 60 years, or up to about 90 years.

An example, not as an attempt to limit the scope of the disclosure, of auseful composition for a dosage form containing about 5-10 mg ofreboxetine (including S,S-reboxetine) is shown in Table 1 below:

TABLE 1 Example of dosage form of reboxetine Component Amount (wt/wt)Reboxetine or 30-70% S,S-reboxetine lubricant  1-10% diluent 20-70%disintegrant  1-10%

Treatment of narcolepsy with cataplexy with reboxetine (includingS,S-reboxetine) in the dosage forms described herein may not havesignificant side effects as the existing treatment options. Treatment ofnarcolepsy with cataplexy with reboxetine (including S,S-reboxetine) inthe dosage forms described herein may be well tolerated in mammals suchas human beings.

Some embodiments include a kit comprising a pharmaceutical compositioncomprising one or more units of a dosage form (e.g. about 1-30, about30-60, about 60-90, about 90-120, about 120-180, about 180-360, or about360-720 units of a dosage form), wherein a unit of the dosage formcomprises about 0.1-5 mg of reboxetine (including S,S-reboxetine) andinstructions to use the pharmaceutical composition to treat narcolepsywith cataplexy in a human being.

Some embodiments include a kit comprising a pharmaceutical compositioncomprising one or more units of a dosage form (e.g. about 1-30, about30-60, about 60-90, about 90-120, about 120-180, about 180-360, or about360-720 units of a dosage form), wherein a unit of the dosage formcomprises about 5-10 mg of reboxetine (including S,S-reboxetine) andinstructions to use the pharmaceutical composition to treat narcolepsywith cataplexy in a human being.

Some embodiments include a kit comprising a pharmaceutical compositioncomprising one or more units of a dosage form (e.g. about 1-30, about30-60, about 60-90, about 90-120, about 120-180, about 180-360, or about360-720 units of a dosage form), wherein a unit of the dosage formcomprises about 10-15 mg of reboxetine (including S,S-reboxetine) andinstructions to use the pharmaceutical composition to treat narcolepsywith cataplexy in a human being.

Some embodiments include a kit comprising a pharmaceutical compositioncomprising one or more units of a dosage form (e.g. about 1-30, about30-60, about 60-90, about 90-120, about 120-180, about 180-360, or about360-720 units of a dosage form), wherein a unit of the dosage formcomprises about 15-20 mg of reboxetine (including S,S-reboxetine) andinstructions to use the pharmaceutical composition to treat narcolepsywith cataplexy in a human being.

Some embodiments include a kit comprising a pharmaceutical compositioncomprising one or more units of a dosage form (e.g. about 1-30, about30-60, about 60-90, about 90-120, about 120-180, about 180-360, or about360-720 units of a dosage form), wherein a unit of the dosage formcomprises about 5-20 mg of reboxetine (including S,S-reboxetine) andinstructions to use the pharmaceutical composition to treat narcolepsywith cataplexy in a human being.

The following embodiments are specifically contemplated.

-   Embodiment 1. A method of treating narcolepsy with cataplexy,    comprising administering reboxetine to a human being in need    thereof, wherein reboxetine is administered at least once daily for    more than two weeks, wherein, two weeks from the beginning of    treatment, the human being experiences a reduction in the number of    cataplexy attacks in a week, a reduction in the Epworth Sleepiness    Scale score, a decrease in the cataplexy subscore on the Ullanlinna    Narcolepsy Scale (NUS), or a reduction in the Maintenance of    Wakefulness Test score as a result of the treatment.-   Embodiment 2. Use of reboxetine in the manufacture of a medicament    for the treatment of narcolepsy with cataplexy, wherein reboxetine    is administered at least once daily for at least three weeks.-   Embodiment 3. A kit comprising a pharmaceutical composition    comprising reboxetine and instructions to use the pharmaceutical    composition to treat narcolepsy with cataplexy in a human being,    wherein reboxetine is administered at least once daily for at least    three weeks.-   Embodiment 4. The method, the use, or the kit of embodiment 1, 2, or    3, wherein reboxetine is administered twice daily, wherein a first    dosage form is administered in the morning and a second dosage form    is administered about 2 hours to about 6 hours later.-   Embodiment 5. The method, the use, or the kit of embodiment 4,    wherein the second dosage form is administered about 2 hours to    about 3 hours after the first dosage form.-   Embodiment 6. The method, the use, or the kit of embodiment 4,    wherein the second dose is administered about 3 hours to about 4    hours after the first dosage form.-   Embodiment 7. The method, the use, or the kit of embodiment 4,    wherein the second dosage form is administered about 4 hours to    about 5 hours after the first dosage form.-   Embodiment 8. The method, the use, or the kit of embodiment 4,    wherein the second dosage form is administered about 5 hours to    about 6 hours after the first dosage form.-   Embodiment 9. The method, the use, or the kit of embodiment 1,    wherein a single dosage form is administered daily, wherein the    single dosage form contains a first release component comprising    reboxetine and a second release component comprising reboxetine,    wherein the first release component provides a first local maximum    in the plasma concentration of reboxetine and the second release    component provides a second local maximum in the plasma    concentration of reboxetine, wherein the first local maximum in the    plasma concentration of reboxetine occurs about 2 to about 6 hours    before the second local maximum in the plasma concentration of    reboxetine.-   Embodiment 10. The method, the use, or the kit of embodiment 9,    wherein the second local maximum in the plasma concentration of    reboxetine occurs about 2 to about 3 hours after the first local    maximum in the plasma concentration of reboxetine.-   Embodiment 11. The method, the use, or the kit of embodiment 9,    wherein the second local maximum in the plasma concentration of    reboxetine occurs about 3 to about 4 hours after the first local    maximum in the plasma concentration of reboxetine.-   Embodiment 12. The method, the use, or the kit of embodiment 9,    wherein the second local maximum in the plasma concentration of    reboxetine occurs about 4 to about 5 hours after the first local    maximum in the plasma concentration of reboxetine.-   Embodiment 13. The method, the use, or the kit of embodiment 9,    wherein the second local maximum in the plasma concentration of    reboxetine occurs about 5 to about 6 hours after the first local    maximum in the plasma concentration of reboxetine.-   Embodiment 14. The method, the use, or the kit of embodiment 1, 2,    3, 4, 5, 6, 7, 8, 9, 10, or 11, 12, or 13, wherein the human being    is selected for not suffering from depression.-   Embodiment 15. The method, the use, or the kit of embodiment 1, 2,    3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, or 14, the dose amount of    reboxetine is increased for 1 to 7 days, and then maintained    constant at a total daily dose of about 0.006 mmol to about 0.01    mmol.-   Embodiment 16. The method, the use, or the kit of embodiment 1, 2,    3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, or 15, wherein the dose    amount of reboxetine is increased for 1 to 7 days, and then    maintained constant at a total daily dose of about 0.01 mmol to    about 0.02 mmol.-   Embodiment 17. The method, the use, or the kit of embodiment 1, 2,    3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, or 15, wherein the dose of    reboxetine is increased for 1 to 7 days, and then maintained    constant at a total daily dose of about 0.02 mmol to about 0.03    mmol.-   Embodiment 18. The method, the use, or the kit of embodiment 1, 2,    3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, or 15, wherein the dose of    reboxetine is increased for 1 to 7 days, and then maintained    constant at a total daily dose of about 0.03 mmol to about 0.04    mmol.-   Embodiment 19. The method, the use, or the kit of embodiment 1, 2,    3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, or 15, wherein the dose of    reboxetine is increased for 1 to 7 days, and then maintained    constant at a total daily dose of about 0.04 mmol to about 0.05    mmol.-   Embodiment 20. The method, the use, or the kit of embodiment 1, 2,    3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, or 15, wherein the dose of    reboxetine is increased for 1 to 7 days, and then maintained    constant at a total daily dose of about 0.05 mmol to about 0.06    mmol.-   Embodiment 21. The method, the use, or the kit of embodiment 1, 2,    3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, or 15, wherein the dose of    reboxetine is increased for 1 to 7 days, and then maintained    constant at a total daily dose of about 0.06 mmol to about 0.07    mmol.-   Embodiment 22. The method, the use, or the kit of embodiment 1, 2,    3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, or 15, wherein the dose of    reboxetine is increased for 1 to 7 days, and then maintained    constant at a total daily dose of about 0.07 mmol to about 0.08    mmol.-   Embodiment 23. The method, the use, or the kit of embodiment 1, 2,    3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21,    or 22, wherein the reboxetine is in a dosage form and the dosage    form contains about 5 mg of reboxetine.-   Embodiment 24. The method, the use, or the kit of embodiment 1, 2,    3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21,    or 22, wherein the reboxetine is in a dosage form and the dosage    form contains about 10 mg of reboxetine.-   Embodiment 25. The method, the use, or the kit of embodiment 23,    wherein the dosage form is administered once daily or twice daily    for at least three weeks.-   Embodiment 26. The method, the use, or the kit of embodiment 24,    wherein the dosage form is administered once daily or twice daily    for at least three weeks.-   Embodiment 27. The method, the use, or the kit of embodiment 1, 2,    3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21,    22, 23, 24, 25, or 26, wherein the human being experiences an    increase in sleep latency on the multiple sleep latency test (MSLT).-   Embodiment 28. The method, the use, or the kit of embodiment 27,    wherein the human being experiences an increase of at least 10% in    sleep latency on the MSLT.-   Embodiment 29. The method, the use, or the kit of embodiment 27,    wherein the human being experiences an increase of at least 20% in    sleep latency on the MSLT.-   Embodiment 30. The method, the use, or the kit of embodiment 27,    wherein the human being experiences an increase of at least 30% in    sleep latency on the MSLT.-   Embodiment 31. The method, the use, or the kit of embodiment 27,    wherein the human being experiences an increase of at least 40% in    sleep latency on the MSLT.-   Embodiment 32. The method, the use, or the kit of embodiment 27,    wherein the human being experiences an increase of at least 50% in    sleep latency on the MSLT.-   Embodiment 33. The method, the use, or the kit of embodiment 27,    wherein the human being experiences an increase of at least 60% in    sleep latency on the MSLT.-   Embodiment 34. The method, the use, or the kit of embodiment 1, 2,    3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21,    22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, or 33, wherein the human    being experiences a decrease of at least 15% in the cataplexy    subscore on the UNS.-   Embodiment 35. The method, the use, or the kit of embodiment 34,    wherein the human being experiences a decrease of at least 20% in    the cataplexy subscore on the UNS.-   Embodiment 36. The method, the use, or the kit of embodiment 34,    wherein the human being experiences a decrease of at least 30% in    the cataplexy subscore on the UNS.-   Embodiment 37. The method, the use, or the kit of embodiment 34,    wherein the human being experiences a decrease of at least 40% in    the cataplexy subscore on the UNS.-   Embodiment 38. The method, the use, or the kit of embodiment 34,    wherein the human being experiences a decrease of at least 50% in    the cataplexy subscore on the UNS.-   Embodiment 39. The method, the use, or the kit of embodiment 34,    wherein the human being experiences a decrease of at least 60% in    the cataplexy subscore on the UNS.-   Embodiment 40. The method, the use, or the kit of embodiment 34,    wherein the human being experiences a decrease of at least 70% in    the cataplexy subscore on the UNS.-   Embodiment 41. The method, the use, or the kit of embodiment 34,    wherein the human being has a cataplexy subscore of about 0.-   Embodiment 42. A method of improving the ability to concentrate in a    human being suffering from narcolepsy, comprising administering    reboxetine to a human being in need thereof.-   Embodiment 43. The method of embodiment 42, wherein the human being    is selected for being in need of improvement in ability to    concentrate or for having difficulty concentrating.-   Embodiment 44. The method of embodiment 42 or 43, wherein, as    compared to before any reboxetine is administered, the human being    has an improvement in the Ability to Concentrate item of the NSAQ    that is at least about −0.1.-   Embodiment 45. A method of treating fibromyalgia, comprising    administering esreboxetine to a human being in need thereof, wherein    a daily dose of about 1 mg to about 2 mg of esreboxetine is    administered for at least six weeks, wherein the human being    experiences a reduction in fibromyalgia pain during the course of    the treatment, as measured by a visual analog scale (VAS) score,    that is greater than the reduction in pain that the human being    would have experienced by administering a placebo.-   Embodiment 46. The method of embodiment 45, wherein about 1 mg to    about 2 mg of esreboxetine is administered once a day.-   Embodiment 47. The method of embodiment 45, wherein about 0.5 mg to    about 1 mg of esreboxetine is administered twice a day.-   Embodiment 48. The method of embodiment 45, 46, or 47, wherein the    human being is selected for having a Global Fatigue Index score of    at least about 8.-   Embodiment 49. The method of embodiment 45, 46, 47, or 48, wherein    after esreboxetine is administered daily for six weeks, the VAS    score of the fibromyalgia pain of the human being is reduced by at    least 20% as compared to the VAS score of the fibromyalgia pain of    the human being immediately prior to administering the first dose of    esreboxetine.-   Embodiment 50. The method of embodiment 45, 46, 47, 48, or 49,    wherein after esreboxetine is administered daily for six weeks, the    VAS score of the fibromyalgia pain of the human being is reduced by    at least 50% as compared to the VAS score of the fibromyalgia pain    of the human being immediately prior to administering the first dose    of esreboxetine.-   Embodiment 51. A method of treating fibromyalgia, comprising    administering esreboxetine to a human being in need thereof, wherein    a daily dose of about 2 mg to about 4 mg of esreboxetine is    administered for at least six weeks, wherein the human being    experiences a reduction in pain during the course of the treatment,    as measured by a visual analog scale (VAS) score, that is greater    than the reduction in pain that the human being would have    experienced by administering a placebo.-   Embodiment 52. The method of embodiment 51, wherein about 1 mg to    about 2 mg of esreboxetine is administered once a day.-   Embodiment 53. The method of embodiment 51, wherein about 0.5 mg to    about 1 mg of esreboxetine is administered twice a day.-   Embodiment 54. The method of embodiment 51, 52, or 53, wherein the    human being is selected for having a Global Fatigue Index score of    at least about 8.-   Embodiment 55. The method of embodiment 51, 52, 53, or 54, wherein    after esreboxetine is administered daily for six weeks, the VAS    score of the fibromyalgia pain of the human being is reduced by at    least 20% as compared to the VAS score of the fibromyalgia pain of    the human being immediately prior to administering the first dose of    esreboxetine.-   Embodiment 56. The method of embodiment 51, 52, 53, 54, or 55,    wherein after esreboxetine is administered daily for six weeks, the    VAS score of the fibromyalgia pain of the human being is reduced by    at least 50% as compared to the VAS score of the fibromyalgia pain    of the human being immediately prior to administering the first dose    of esreboxetine.-   Embodiment 57. A method of treating fibromyalgia, comprising    administering esreboxetine to a human being in need thereof, wherein    a daily dose of about 0.5 mg to about 1 mg of esreboxetine is    administered for at least six weeks, wherein the human being    experiences a reduction in pain during the course of the treatment,    as measured by a visual analog scale (VAS) score, that is greater    than the reduction in pain that the human being would have    experienced by administering a placebo.-   Embodiment 58. The method of embodiment 57, wherein about 1 mg to    about 2 mg of esreboxetine is administered once a day.-   Embodiment 59. The method of embodiment 57, wherein about 0.5 mg to    about 1 mg of esreboxetine is administered twice a day.-   Embodiment 60. The method of embodiment 57, 58, or 59, wherein the    human being is selected for having a Global Fatigue Index score of    at least about 8.-   Embodiment 61. The method of embodiment 57, 58, 59, or 60, wherein    after esreboxetine is administered daily for six weeks, the VAS    score of the fibromyalgia pain of the human being is reduced by at    least 20% as compared to the VAS score of the fibromyalgia pain of    the human being immediately prior to administering the first dose of    esreboxetine.-   Embodiment 62. The method of embodiment 61, wherein after    esreboxetine is administered daily for six weeks, the VAS score of    the fibromyalgia pain of the human being is reduced by at least 50%    as compared to the VAS score of the fibromyalgia pain of the human    being immediately prior to administering the first dose of    esreboxetine.

EXAMPLES Example 1

A 40 year old male is diagnosed as suffering from narcolepsy withcataplexy. He is given reboxetine and instructed to take 5 mg ofreboxetine at 8 am and 5 mg of reboxetine at 1 pm for three weeks. Thepatient is evaluated prior to treatment, and weekly to determine the MWTscore, the number of cataplexy attacks, the PGI-C score, the HAM-Dscore, the ESS score, the NSAQ score, and the ability to concentrate onthe NSAQ. After one week of treatment, the number of cataplexy attackshave decreased by 10-30%.

Example 2

A 20 year old female is diagnosed as suffering from narcolepsy withcataplexy. She is given reboxetine and instructed to take 5 mg ofreboxetine at 8 am and 5 mg of reboxetine at 1 pm for three weeks. Thepatient is evaluated prior to treatment, and weekly to determine the MWTscore, the number of cataplexy attacks, the PGI-C score, the HAM-Dscore, the ESS score, the NSAQ score, and the ability to concentrate onthe NSAQ. After one week of treatment, the number of cataplexy attackshave decreased by 30-60%.

Example 3

A 60 year old male is diagnosed as suffering from narcolepsy withcataplexy. He is given reboxetine and instructed to take 5 mg ofreboxetine at 8 am and 5 mg of reboxetine at 1 pm for three weeks. Thepatient is evaluated prior to treatment, and weekly to determine the MWTscore, the number of cataplexy attacks, the PGI-C score, the HAM-Dscore, the ESS score, the NSAQ score, and the ability to concentrate onthe NSAQ. After one week of treatment, the number of cataplexy attackshave decreased by 60-100%.

Example 4

A 50 year old female is diagnosed as suffering from narcolepsy withcataplexy. She is given reboxetine and instructed to take 5 mg ofreboxetine at 8 am and 5 mg of reboxetine at 1 pm for three weeks. Thepatient is evaluated prior to treatment, and weekly to determine the MWTscore, the number of cataplexy attacks, the PGI-C score, the HAM-Dscore, the ESS score, the NSAQ score, and the ability to concentrate onthe NSAQ. After one week of treatment, the ESS score has decreased by10-30%.

Example 5

A 25 year old male is diagnosed as suffering from narcolepsy withcataplexy. He is given reboxetine and instructed to take 5 mg ofreboxetine at 8 am and 5 mg of reboxetine at 1 pm for three weeks. Thepatient is evaluated prior to treatment, and weekly to determine the MWTscore, the number of cataplexy attacks, the PGI-C score, the HAM-Dscore, the ESS score, the NSAQ score, and the ability to concentrate onthe NSAQ. After one week of treatment, the ESS score has decreased by30-60%.

Example 6

A 47 year old female is diagnosed as suffering from narcolepsy withcataplexy. She is given reboxetine and instructed to take 5 mg ofreboxetine at 8 am and 5 mg of reboxetine at 1 pm for three weeks. Thepatient is evaluated prior to treatment, and weekly to determine the MWTscore, the number of cataplexy attacks, the PGI-C score, the HAM-Dscore, the ESS score, the NSAQ score, and the ability to concentrate onthe NSAQ. After one week of treatment, the ESS score has decreased by60-100%.

Example 7

A 19 year old male is diagnosed as suffering from narcolepsy withcataplexy. He is given reboxetine and instructed to take 5 mg ofreboxetine at 8 am and 5 mg of reboxetine at 1 pm for three weeks. Thepatient is evaluated prior to treatment, and weekly to determine the MWTscore, the number of cataplexy attacks, the PGI-C score, the HAM-Dscore, the ESS score, the NSAQ score, and the ability to concentrate onthe NSAQ. After one week of treatment, the MWT score has decreased by10-30%.

Example 8

A 42 year old female is diagnosed as suffering from narcolepsy withcataplexy. She is given reboxetine and instructed to take 5 mg ofreboxetine at 8 am and 5 mg of reboxetine at 1 pm for three weeks. Thepatient is evaluated prior to treatment, and weekly to determine the MWTscore, the number of cataplexy attacks, the PGI-C score, the HAM-Dscore, the ESS score, the NSAQ score, and the ability to concentrate onthe NSAQ. After one week of treatment, the MWT score has decreased by30-60%.

Example 9

A 33 year old male is diagnosed as suffering from narcolepsy withcataplexy. He is given reboxetine and instructed to take 5 mg ofreboxetine at 8 am and 5 mg of reboxetine at 1 pm for three weeks. Thepatient is evaluated prior to treatment, and weekly to determine the MWTscore, the number of cataplexy attacks, the PGI-C score, the HAM-Dscore, the ESS score, the NSAQ score, and the ability to concentrate onthe NSAQ. After one week of treatment, the MWT score has decreased by60-100%.

Example 10

A 54 year old male is diagnosed as suffering from narcolepsy withcataplexy. He is given reboxetine and instructed to take 5 mg ofreboxetine at 8 am and 5 mg of reboxetine at 1 pm for three weeks. Thepatient is evaluated prior to treatment, and weekly to determine the MWTscore, the number of cataplexy attacks, the PGI-C score, the HAM-Dscore, the ESS score, the NSAQ score, and the ability to concentrate onthe NSAQ. After three weeks of treatment, the number of cataplexyattacks have decreased by 10-30%.

Example 11

A 27 year old female is diagnosed as suffering from narcolepsy withcataplexy. She is given reboxetine and instructed to take 5 mg ofreboxetine at 8 am and 5 mg of reboxetine at 1 pm for three weeks. Thepatient is evaluated prior to treatment, and weekly to determine the MWTscore, the number of cataplexy attacks, the PGI-C score, the HAM-Dscore, the ESS score, the NSAQ score, and the ability to concentrate onthe NSAQ. After three weeks of treatment, the number of cataplexyattacks have decreased by 30-60%.

Example 12

A 52 year old male is diagnosed as suffering from narcolepsy withcataplexy. He is given reboxetine and instructed to take 5 mg ofreboxetine at 8 am and 5 mg of reboxetine at 1 pm for three weeks. Thepatient is evaluated prior to treatment, and weekly to determine the MWTscore, the number of cataplexy attacks, the PGI-C score, the HAM-Dscore, the ESS score, the NSAQ score, and the ability to concentrate onthe NSAQ. After three weeks of treatment, the number of cataplexyattacks have decreased by 60-100%.

Example 13

A 66 year old female is diagnosed as suffering from narcolepsy withcataplexy. She is given reboxetine and instructed to take 5 mg ofreboxetine at 8 am and 5 mg of reboxetine at 1 pm for three weeks. Thepatient is evaluated prior to treatment, and weekly to determine the MWTscore, the number of cataplexy attacks, the PGI-C score, the HAM-Dscore, the ESS score, the NSAQ score, and the ability to concentrate onthe NSAQ. After three weeks of treatment, the ESS score has decreased by10-30%.

Example 14

A 34 year old male is diagnosed as suffering from narcolepsy withcataplexy. He is given reboxetine and instructed to take 5 mg ofreboxetine at 8 am and 5 mg of reboxetine at 1 pm for three weeks. Thepatient is evaluated prior to treatment, and weekly to determine the MWTscore, the number of cataplexy attacks, the PGI-C score, the HAM-Dscore, the ESS score, the NSAQ score, and the ability to concentrate onthe NSAQ. After three weeks of treatment, the ESS score has decreased by30-60%.

Example 15

A 35 year old female is diagnosed as suffering from narcolepsy withcataplexy. She is given reboxetine and instructed to take 5 mg ofreboxetine at 8 am and 5 mg of reboxetine at 1 pm for three weeks. Thepatient is evaluated prior to treatment, and weekly to determine the MWTscore, the number of cataplexy attacks, the PGI-C score, the HAM-Dscore, the ESS score, the NSAQ score, and the ability to concentrate onthe NSAQ. After three weeks of treatment, the ESS score has decreased by60-100%.

Example 16

A 19 year old male is diagnosed as suffering from narcolepsy withcataplexy. He is given reboxetine and instructed to take 5 mg ofreboxetine at 8 am and 5 mg of reboxetine at 1 pm for three weeks. Thepatient is evaluated prior to treatment, and weekly to determine the MWTscore, the number of cataplexy attacks, the PGI-C score, the HAM-Dscore, the ESS score, the NSAQ score, and the ability to concentrate onthe NSAQ. After three weeks of treatment, the MWT score has decreased by10-30%.

Example 17

A 70 year old female is diagnosed as suffering from narcolepsy withcataplexy. She is given reboxetine and instructed to take 5 mg ofreboxetine at 8 am and 5 mg of reboxetine at 1 pm for three weeks. Thepatient is evaluated prior to treatment, and weekly to determine the MWTscore, the number of cataplexy attacks, the PGI-C score, the HAM-Dscore, the ESS score, the NSAQ score, and the ability to concentrate onthe NSAQ. After three weeks of treatment, the MWT score has decreased by30-60%.

Example 18

A 57 year old male is diagnosed as suffering from narcolepsy withcataplexy. He is given reboxetine and instructed to take 5 mg ofreboxetine at 8 am and 5 mg of reboxetine at 1 pm for three weeks. Thepatient is evaluated prior to treatment, and weekly to determine the MWTscore, the number of cataplexy attacks, the PGI-C score, the HAM-Dscore, the ESS score, the NSAQ score, and the ability to concentrate onthe NSAQ. After three weeks of treatment, the MWT score has decreased by60-100%.

Example 19

A 20 year old female is diagnosed as suffering from narcolepsy withcataplexy. She is given reboxetine and instructed to take 5 mg ofreboxetine at 8 am and 5 mg of reboxetine at 1 pm for three weeks. Thepatient is evaluated prior to treatment, and weekly to determine the MWTscore, the number of cataplexy attacks, the PGI-C score, the HAM-Dscore, the ESS score, the NSAQ score, and the ability to concentrate onthe NSAQ. After three weeks of treatment, the HAM-D score has decreasedby 10-30%.

Example 20

A 69 year old male is diagnosed as suffering from narcolepsy withcataplexy. He is given reboxetine and instructed to take 5 mg ofreboxetine at 8 am and 5 mg of reboxetine at 1 pm for three weeks. Thepatient is evaluated prior to treatment, and weekly to determine the MWTscore, the number of cataplexy attacks, the PGI-C score, the HAM-Dscore, the ESS score, the NSAQ score, and the ability to concentrate onthe NSAQ. After three weeks of treatment, the HAM-D score has decreasedby 30-60%.

Example 21

A 56 year old female is diagnosed as suffering from narcolepsy withcataplexy. She is given reboxetine and instructed to take 5 mg ofreboxetine at 8 am and 5 mg of reboxetine at 1 pm for three weeks. Thepatient is evaluated prior to treatment, and weekly to determine the MWTscore, the number of cataplexy attacks, the PGI-C score, the HAM-Dscore, the ESS score, the NSAQ score, and the ability to concentrate onthe NSAQ. After three weeks of treatment, the HAM-D score has decreasedby 60-100%.

Example 22

A Phase 2, double-blind, randomized, placebo-controlled, crossover,multicenter trial of reboxetine was carried out in patients withnarcolepsy. A total of 21 patients with a diagnosis of narcolepsy withcataplexy were treated for 2 weeks with reboxetine or with placebo,followed by a crossover to the other treatment after a 1-weekdown-titration and washout period. Reboxetine was administered orallytwice daily, with a total daily dose of 8 mg for Week 1 which wasescalated to 10 mg for Week 2. Patients were randomized in a 1:1 ratioeither to treatment with reboxetine followed by placebo (sequence 1), orto treatment with placebo followed by reboxetine (sequence 2). Theaverage number of cataplexy attacks at baseline was 30. Key assessmentswere made daily using an electronic diary. The prespecified primaryendpoint was the change in the weekly number of cataplexy attacks,averaged over the 2-week treatment period (overall treatment effect).Secondary endpoints included changes in the number of inadvertent naps,cognition, and Epworth Sleepiness Scale. Cognition was assessed usingthe Ability to Concentrate item of the Narcolepsy Symptom AssessmentQuestionnaire, a patient reported outcome measure. This item is rated on5-point scale (1=very good to 5=very poor). All analyses were conductedon an intent-to-treat basis.

As shown in FIG. 1, Reboxetine met the prespecified primary endpoint bydemonstrating a highly statistically significant reduction from baselinein the mean weekly number of cataplexy attacks, averaged for the 2-weektreatment period (overall treatment effect), as compared to placebo(p<0.001). At Week 2, reboxetine demonstrated a mean reduction of 14.6cataplexy attacks per week compared to a reduction of 2.6 attacks perweek for placebo (p=0.002), representing mean reductions of 48.7% and8.7% from baseline, respectively (FIG. 1). Furthermore, Reboxetinetreatment resulted in rapid reduction in the cataplexy attacks. After1-week treatment, reboxetine demonstrated a mean reduction of 13.0cataplexy attacks compared to a reduction of 0.3 attacks for placebo(p<0.001), representing mean reductions of 43.3% and 1.0% from baseline,respectively (FIG. 1). The proportion of patients achieving a 50% orgreater reduction in the weekly number of cataplexy attacks was 76.2%for reboxetine, compared to 30.0% for placebo (p=0.003) at Week 2 (FIG.2). The proportion of patients achieving a 75% or greater reduction inthe weekly number of cataplexy attacks was 42.9% for reboxetine,compared to 10.0% for placebo (p=0.018) at Week 2 (FIG. 3). Theimprovement in cataplexy was rapid with reboxetine demonstratingsignificant benefit over placebo as early as Week 1 (p<0.001).

Reboxetine significantly improved EDS (excessive daytime sleepiness)symptoms compared to placebo, as measured by the Epworth SleepinessScale (ESS) and by the frequency of inadvertent naps. As shown in FIG.4, the improvement on the ESS with reboxetine treatment was twice thatobserved with placebo, with reductions in the ESS score from baseline of6.0 and 3.1, respectively for reboxetine and placebo (p=0.003).Reboxetine treatment resulted in a 31.8% mean reduction from baseline inthe average weekly number of inadvertent naps versus a 5.3% meanreduction for placebo (p<0.001) at Week 2 (FIG. 5). As shown in FIG. 6,reboxetine treatment resulted in a greater number of patients with 50%or greater reduction in inadvertent naps (38.1%) as compared to placebo(10.0%) (p=0.036). The improvement in frequency of inadvertent naps wasrapid with reboxetine demonstrating significant benefit over placebo asearly as Week 1.

Reboxetine significantly improved cognitive function compared to placeboover the 2-week treatment period as measured by the Ability toConcentrate item of the Narcolepsy Symptom Assessment Questionnaire(NSAQ), which was assessed daily (p<0.01) (FIGS. 7-8). For thisassessment, patients rated their ability to concentrate on a 5-pointscale (1=very good, 2=good, 3=average, 4=poor, and 5=very poor). At theend of the 2-week treatment period, 42.9% of patients had an ability toconcentrate that was “good” to “very good” with reboxetine treatment,compared to 25.0% of patients with placebo, and 0% of patients atbaseline. The improvement in the ability to concentrate was rapid withreboxetine demonstrating significant improvement over placebo (38.1% vs15.0%) as early as Week 1 (p=0.007).

Reboxetine significantly improved sleep quality, as measured by overallimprovement and by number of awakenings at night, and reducedsleep-related symptoms, as compared to placebo. As shown in FIG. 9,reboxetine treatment resulted in 45.0% of patients reporting improvedsleep quality versus 5.3% of patients with placebo (p=0.007). Reboxetinetreatment resulted in 30.0% of patients reporting a reduction in thenumber of awakenings at night versus 5.3% of patients with placebo(p=0.044). Reboxetine treatment also resulted in greater proportion ofpatients with reductions in sleep paralysis episodes, and in hypnagogichallucinations, as compared to placebo.

Reboxetine was safe and well tolerated. There were no serious adverseevents reported in the trial, and no discontinuations due to adverseevents. The overall percentage of patients experiencing adverse eventswas 42.9% with reboxetine and 40.0% with placebo, with the most commonlyreported adverse events with reboxetine treatment being anxiety,constipation, and insomnia. The completion rate was 91% for patientsrandomized to treatment sequence 1 (reboxetine followed by placebo) and100% for those randomized to sequence 2 (placebo followed byreboxetine).

Unless otherwise indicated, all numbers expressing quantities ofingredients, properties such as amounts, percentage, and so forth usedin the specification and claims are to be understood in all instances asindicating both the exact values as shown and as being modified by theterm “about.” Accordingly, unless indicated to the contrary, thenumerical parameters set forth in the specification and attached claimsare approximations that may vary depending upon the desired propertiessought to be obtained. At the very least, and not as an attempt to limitthe application of the doctrine of equivalents to the scope of theclaims, each numerical parameter should at least be construed in lightof the number of reported significant digits and by applying ordinaryrounding techniques.

The terms “a,” “an,” “the” and similar referents used in the context ofdescribing the embodiments (especially in the context of the followingclaims) are to be construed to cover both the singular and the plural,unless otherwise indicated herein or clearly contradicted by context.All methods described herein can be performed in any suitable orderunless otherwise indicated herein or otherwise clearly contradicted bycontext. The use of any and all examples, or exemplary language (e.g.,“such as”) provided herein is intended merely to better illuminate theembodiments and does not pose a limitation on the scope of any claim. Nolanguage in the specification should be construed as indicating anynon-claimed element essential to the practice of the claims.

Groupings of alternative elements or embodiments disclosed herein arenot to be construed as limitations. Each group member may be referred toand claimed individually or in any combination with other members of thegroup or other elements found herein. It is anticipated that one or moremembers of a group may be included in, or deleted from, a group forreasons of convenience and/or to expedite prosecution. When any suchinclusion or deletion occurs, the specification is deemed to contain thegroup as modified thus fulfilling the written description of all Markushgroups if used in the appended claims.

Certain embodiments are described herein, including the best mode knownto the inventors for carrying out the claimed embodiments. Of course,variations on these described embodiments will become apparent to thoseof ordinary skill in the art upon reading the foregoing description. Theinventor expects skilled artisans to employ such variations asappropriate, and the inventors intend for the claimed embodiments to bepracticed otherwise than specifically described herein. Accordingly, theclaims include all modifications and equivalents of the subject matterrecited in the claims as permitted by applicable law. Moreover, anycombination of the above-described elements in all possible variationsthereof is contemplated unless otherwise indicated herein or otherwiseclearly contradicted by context.

In closing, it is to be understood that the embodiments disclosed hereinare illustrative of the principles of the claims. Other modificationsthat may be employed are within the scope of the claims. Thus, by way ofexample, but not of limitation, alternative embodiments may be utilizedin accordance with the teachings herein. Accordingly, the claims are notlimited to embodiments precisely as shown and described.

The invention claimed is:
 1. A method of rapidly reducing the number ofcataplexy attacks in a human being having narcolepsy with cataplexy,comprising administering 8 mg to 10 mg of reboxetine daily for at leasttwo weeks to the human being in need of treatment of reboxetine, whereinthe human being has a minimum of 7 cataplexy attacks per week prior toreceiving the reboxetine.
 2. The method of claim 1, wherein thereduction in the number of cataplexy attacks is statisticallysignificant as compared to administering a placebo with p value that isless than 0.01.
 3. The method of claim 1, wherein 4 mg of the reboxetineis administered twice a day to the human being for a first week.
 4. Themethod of claim 3, wherein 4 mg of the reboxetine is administered to thehuman being in the morning and 4 mg of the reboxetine is administered tothe human being in the afternoon for a second week.
 5. The method ofclaim 1, wherein 6 mg of the reboxetine is administered to the humanbeing in the morning and 4 mg of the reboxetine is administered to thehuman being in the afternoon for a first week.
 6. The method of claim 1,wherein the human being has a diagnosis of narcolepsy with cataplexythat meets International Classification of Sleep Disorders, ThirdEdition criteria.
 7. The method of claim 1, wherein the human being hasan Epworth Sleepiness Scale score that is greater than 10 prior toreceiving the reboxetine.
 8. The method of claim 5, wherein 6 mg of thereboxetine is administered to the human being in the morning and 4 mg ofthe reboxetine is administered to the human being in the afternoon for asecond week.
 9. The method of claim 1, wherein 5 mg of the reboxetine isadministered to the human being in the morning and 5 mg of thereboxetine is administered to the human being in the afternoon for afirst week.
 10. The method of claim 9, wherein 5 mg of the reboxetine isadministered to the human being in the morning and 5 mg of thereboxetine is administered to the human being in the afternoon for asecond week.
 11. The method of claim 1, wherein one week after the startof the treatment, the human being has at least 30% fewer cataplexyattacks as compared to baseline.
 12. The method of claim 1, wherein twoweeks after the start of the treatment, the human being has at least 40%fewer cataplexy attacks as compared to baseline.
 13. The method of claim1, wherein one week after the start of the treatment, the human being ismore likely to achieve a 50% or greater reduction in the weekly numberof cataplexy attacks as compared with taking a placebo for one week. 14.The method of claim 1, wherein two weeks after the start of thetreatment, the human being is more likely to achieve a 50% or greaterreduction in the weekly number of cataplexy attacks as compared withtaking a placebo for 2 weeks.
 15. The method of claim 1, wherein oneweek after the start of the treatment, the human being is more likely toachieve a 75% or greater reduction in the weekly number of cataplexyattacks as compared with taking a placebo for one week.
 16. The methodof claim 1, wherein two weeks after the start of the treatment, thehuman being is more likely to achieve a 50% or greater reduction in theweekly number of cataplexy attacks as compared with taking a placebo for2 weeks.